343614546-6-25-2019-03-CC-SDLA-BDGRGZ-20190625130135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343614546
Report Date: 06/25/2019
Date Signed: 06/25/2019 01:01:39 PM

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:	SHALOM PRESCHOOL		FACILITY NUMBER:	343614546
ADMINISTRATOR:	LAURA HALEN		FACILITY TYPE:	830
ADDRESS:	2320 SIERRA BLVD.		TELEPHONE:	(916) 485-4151
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	34	CENSUS: 25	DATE:	06/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Stacey Worthen		TIME COMPLETED:	01:15 PM

NARRATIVE

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Licensing Program Analyst (LPA) Seychelle De Luca and Staff Attorney (SA) Nicole Egan met with Designee Stacey Worthen for the purpose of an unannounced annual random inspection. Designee was reminded never to exceed the conditions, limitations, and capacity specified on the license. Upon arrival LPA and SA observed 25 infant children with 11 staff members. Facility hours of operation are Monday through Friday from 7:30 AM to 6:00 PM.

LPA and SA toured classrooms, restrooms, kitchen, and the outdoor play areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants, hazardous items, and medications are appropriately stored and inaccessible to children. Designee stated there are no poisons on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. Infant changing tables have a padded surface that is washable and at least one inch thick. The floors appeared clean throughout the facility. The food preparation space is free of litter, all food was protected against contamination, and storage containers with solid waste have tight-fitting covers. Program provides morning and afternoon snacks; and parents provide lunches and bottled milk. Drinking water was readily available to children both indoors and outdoors. LPA observed full legal signatures while reviewing the sign in and sign out sheet.

Staff and children's records were reviewed. Each child's file contained an emergency card, a health history, and Infant Needs and Services Plan. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 08/2020).

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

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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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: SHALOM PRESCHOOL	FACILITY NUMBER: 343614546
	VISIT DATE: 06/25/2019

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All staff currently employed with the facility have a criminal record clearance, health screening report, immunization records, AB 1207 Mandated Reporter Training certificates, and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with Designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.

A Plan of Operation is available in the facility file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Director can request to be added to the distribution list to receive Quarterly Updates. LPA provided and discussed Safe Sleep in Child Care, Effects of Lead Exposure, Health Schools Act, and Safe Sleep Environment brochures.

This facility evaluation report was reviewed and discussed with Designee. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Designee was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

LIC809 (FAS) - (06/04)

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