550321246-10-22-2021-53-CC-ASRN-C82QGQ-20211022120956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 550321246
Report Date: 10/22/2021
Date Signed: 10/22/2021 12:10:14 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:	KOUNTRY KIDS PRESCHOOL		FACILITY NUMBER:	550321246
ADMINISTRATOR:	ECROYD, DENISE		FACILITY TYPE:	850
ADDRESS:	229 SOUTH SHEPHERD STREET		TELEPHONE:	(209) 533-1500
CITY:	SONORA	STATE: CA	ZIP CODE:	95370
CAPACITY:	60	CENSUS: 34	DATE:	10/22/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Ann Vorhies		TIME COMPLETED:	12:15 PM

NARRATIVE

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At 8:45 am on 10/22/21 Licensing Program Analyst (LPA) Aruna Sridharan met with Facility Representative Ann Voorhies, Assistant Director at the preschool for an unannounced annual random inspection. Facility operates in three rooms. Upon arrival, LPA observed 6 toddlers, 28 preschool children in three classrooms with toddler in a separate classroom. There were 5 staff members apart from the assistant director. Facility hours of operation are Monday through Friday 7:15AM to 5:30PM. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license.
LPA toured all activity and classroom spaces, kitchen, children and staff restrooms, and outdoor play areas. Medications are appropriately stored and inaccessible to children in care. Toxic and hazardous items are stored in upper cabinets in restrooms inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with bark to absorb the fall. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Facility provides snacks and lunch for children. Menus are posted and drinking water is readily available to children both indoors and outdoors. LPA observed sign-in and sign-out sheets.

All 6 staff and 11 children's records were reviewed. Each child's file contained an emergency card. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 11/2022). All staff currently employed with the facility have a criminal record clearance and documentation of the educational background, training, and/or experience, proof of immunizations and mandated reporter trainings.

Report continues on 809-C.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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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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: KOUNTRY KIDS PRESCHOOL	FACILITY NUMBER: 550321246
	VISIT DATE: 10/22/2021

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There are no firearms or bodies of water on the premises. LPAs reviewed the Department's inspection authority and discussed with Facility Representative any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility provides 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility Representative was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. In the areas that were evaluated, no deficiencies were cited on today’s date.

Exit interview was conducted and report was reviewed with Facility Representative. A Notice of Site Visit was provided and should remain posted for a period of 30 days.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

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