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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614437
Report Date: 04/08/2022
Date Signed: 04/08/2022 01:33:52 PM


Document Has Been Signed on 04/08/2022 01:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:KOHLER PRESCHOOLFACILITY NUMBER:
343614437
ADMINISTRATOR:BRITTANY GARRETTFACILITY TYPE:
850
ADDRESS:4004 BRUCE WAYTELEPHONE:
(916) 566-1850
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:72CENSUS: 10DATE:
04/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Brittany GarrettTIME COMPLETED:
02:00 PM
NARRATIVE
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On April 8, 2022 at 12:20 PM, Licensing Program Analyst Tanya Washington met with Substitute Teacher Melanie Pinto- Garcia for an unannounced case management inspection. During today's inspection LPA observed care and supervision of 10 napping children in classroom #3 supervised by two staff. Approximately at 1:00 PM, Site Supervisor Brittany Garrett arrived to the facility and assisted LPA with the remained of the visit.

Facility self reported an incident which occurred on 03/23/2022. It was reported that while two children were napping on cots in classroom #3, Staff #1 briefly walked out of the classroom and the door to the room automatically locked. Staff #1 had a key on their badge and immediately unlocked the door and entered the classroom. Staff #1 stated that the door was locked for a brief moment. When Staff #1 entered the classroom the children were still napping on their cots.

Since the incident, facility has installed a white board by the classroom door which indicates the number of children inside and outside. Facility staff will also thoroughly sweep the classroom before exiting and count the children as they enter and exit any area.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.

This report was reviewed and discussed with Site Supervisor. A copy of the report and appeal rights are provided. Notice of site visit was provided and shall be posted for 30 days for parental review.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/08/2022 01:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: KOHLER PRESCHOOL
FACILITY NUMBER: 343614437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/08/2022
Section Cited

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No children shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).
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Supervision shall include visual observation. This requirement is not met as evidenced: Staff #1 briefly walked out of the classroom, the door automatically locked while two children were still napping on cots. This is an immediate risk to the health and safety of children in care.
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to count children and thoroughly sweep areas for children prior to exiting any areas.

Deficiency is cleared as of today.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
LIC809 (FAS) - (06/04)
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