093624710-4-21-2023-03-CC-EPGO-CR4T2Z-20230421142134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093624710
Report Date: 04/21/2023
Date Signed: 04/21/2023 02:21:43 PM

Document Has Been Signed on 04/21/2023 02:21 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	SMART START PRESCHOOL CAMERON PARK		FACILITY NUMBER:	093624710
ADMINISTRATOR:	JAYNE, AMBER		FACILITY TYPE:	850
ADDRESS:	2558 GREENWOOD LANE SUITE A		TELEPHONE:	(916) 303-0851
CITY:	CAMERON PARK	STATE: CA	ZIP CODE:	95682
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 21	DATE:	04/21/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Amber Jayne		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Manager (LPM) Natalie Dunaway and Licensing Program Analyst (LPA) Erwina Pascual-Golamco met with Applicant Amber Jayne for the purpose of an announced pre-licensing change of ownership inspection. Applicant requests a preschool license to serve 38 preschool children from age two to entry into first grade. The program will operate Monday through Friday from 7:30 AM to 5:30 PM. LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, and daily schedule. Applicant submitted a written statement that the center does not prepare food, and the water used for drinking will be from a bottled water service. INDOOR ACTIVITY SPACE: The classroom area measured 1364.195. LPA observed a sufficient number of tables, chairs, cubbies, and napping cots for 38 preschool children. LPA observed a variety of age-appropriate toys and equipment. There is a first aid kit. LPA observed water accessible to children. Medications will be stored in the office in a locked box. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPA observed a functional carbon monoxide detector. LPA observed an electronic sign-in/sign-out system. Report continues on 809-C.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: SMART START PRESCHOOL CAMERON PARK	FACILITY NUMBER: 093624710
	VISIT DATE: 04/21/2023

NARRATIVE

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There are three toilets and three sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property for preschool children. The outdoor play area is fenced with a fence that is at least four feet tall and the preschool yard is separate from the infant yard. LPA observed a variety of age-appropriate outdoor toys and equipment. LPA observed bark beneath the structure. There are no bodies of water on the premises. There are shaded areas supplied by trees and umbrellas.

LPA measured the outdoor activity space. The outdoor play area contains a total of 6291 square feet, which accommodates Applicant's request for 38 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant 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.

Report continues on 809-C.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: SMART START PRESCHOOL CAMERON PARK	FACILITY NUMBER: 093624710
	VISIT DATE: 04/21/2023

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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

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/inspection-process

Applicant 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.

The following items are required before a license will be issued:

1. Licensing Program Manager’s final file review.

2. A new fire clearance must be granted by the fire inspector for 38 preschool children.

3. A revised application must be submitted, reflecting a capacity request of 38 preschool children.

Exit interview conducted and report was reviewed with the applicant Amber Jayne.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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