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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623051
Report Date: 10/21/2021
Date Signed: 10/21/2021 12:35:04 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:KIDS PARK-FOLSOM(PS)FACILITY NUMBER:
343623051
ADMINISTRATOR:NASLUND, JULIAFACILITY TYPE:
850
ADDRESS:1111 RILEY STREETTELEPHONE:
(916) 293-8786
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:60CENSUS: 16DATE:
10/21/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ladan KavanTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Kelly Ferrara conducted a Plan of Correction inspection at the facility and met with Facility Representative Ladan Kavan. On October 21st, 2021, LPA observed 16 children in care with three staff.

On October 6th, 2021, LPA issued the following citations:

101170(e) Staff present did not have their fingerprint clearance associated to the facility license. LPA observed an updated staff roster in Guardian where the staff is now associated to the center.

1596.7995(a)(1) Staff files did not show proof of immunizations. LPA reviewed staff files and observed proof of immunization record.

1596.8662(b)(1) Staff did not have a current Mandated Reporter certificate. LPA reviewed staff files and observed proof the staff have taken the training.

101216(g)(1) Staff did not have a Health Screen (LIC503) on file. LPA reviewed staff files and observed a Health Screen for each staff.

LPA was able to clear the citations issued and provided letters as proof.

There were no deficiencies cited based on today's inspection. LPA provided a Notice of Site visit that must remain posted for 30 days for parental review.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021
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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