343616796-9-15-2023-03-CC-JGAG-CVPPGS-20230915111849

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616796
Report Date: 09/15/2023
Date Signed: 09/15/2023 11:18:54 AM

Document Has Been Signed on 09/15/2023 11:18 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	OUR LADY OF THE ASSUMPTION		FACILITY NUMBER:	343616796
ADMINISTRATOR:	ANN MARIE DUESBURY		FACILITY TYPE:	850
ADDRESS:	5055 COTTAGE WAY		TELEPHONE:	(916) 485-1504
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	33	CENSUS: 29	DATE:	09/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Sarah Beck		TIME COMPLETED:	11:30 AM

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On September 15, 2023 at approximately 9:45 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Director Sarah Beck for the purpose of an unannounced annual random inspection. LPA observed care and supervision of 29 preschool children by four staff. All persons requiring criminal background checks have been cleared. The facility has a maximum capacity of 33. The facility hours of operation are Monday through Friday from 7:45 AM to 5:00 PM.

LPA toured the classrooms, restroom, kitchen, office, and outdoor play area. Director stated there are no firearms on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts and the ground below the play structure is sufficiently padded. Restrooms are in sanitary condition with functioning toilets. The floors were clean throughout the facility.

LPA observed that solid waste containers were covered. Facility provides snacks for children and parents provide lunch. Drinking water was readily available to children both indoors and outdoors. LPA observed sign in and out sheets complete with parents signatures.

All present staff files were reviewed. LPA observed a current Mandated Reporter certificates and current CPR and First Aid certificate which will expire January 17, 2025.

LPA reviewed a sample of children’s files and observed them to be complete. LPA observed a fire drill log and current roster of children. LPA observed first aid equipment, functioning smoke and carbon monoxide detectors, and fully charged fire extinguishers meeting regulation. Required documents were posted.

Report continues on LIC809-C…

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah Gathing	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OUR LADY OF THE ASSUMPTION	FACILITY NUMBER: 343616796
	VISIT DATE: 09/15/2023

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LPA discussed Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Director was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.

No deficiencies were cited based on today’s inspection. Exit interview was conducted and report was reviewed with the Director. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah Gathing	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC809 (FAS) - (06/04)

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