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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093624710
Report Date: 01/08/2025
Date Signed: 01/09/2025 07:54:26 AM

Document Has Been Signed on 01/09/2025 07:54 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:SMART START PRESCHOOL CAMERON PARKFACILITY NUMBER:
093624710
ADMINISTRATOR/
DIRECTOR:		BOOTH, SHANNAHFACILITY TYPE:
850
ADDRESS:2558 GREENWOOD LANE SUITE ATELEPHONE:
(916) 303-0851
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 31DATE:
01/08/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:25 AM
MET WITH:Shannah BoothTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Erwina Pascual-Golamco, met with Director (D) Shannah Booth, for a case management inspection. Purpose of the inspection was explained.

During today's visit, at approximately 8:18AM, while LPA was writing a report in the office area, LPA observed a child go in from the playground without staff knowledge. LPA checked through window if staff was aware of the incident, and LPA observe staff was attending to other children in the playground. LPA walked the child over to another staff member inside the facility, staff talked to the child, and child stayed with staff indoors until another staff came in to help.

Based on LPA observation, a deficiency has been issued on the attached LIC809-D page. Director was informed that the Type A deficiency cited today is for absence of supervision. Director shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. Exit interview was conducted with Director, appeal rights were provided, and A notice of site visit was given to Director, who will post it where visible to parents/guardians for 30 days. A signed Acknowledgement of Receipt of the Licensing Report (LIC9224) must be placed in the child's file for verification.

continued on LIC809-D...

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/09/2025 07:54 AM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 01/08/2025 at 10:15 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SMART START PRESCHOOL CAMERON PARK
FACILITY NUMBER: 093624710

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/09/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...shall include visual observation.
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Director stated they will install an alarm or bells on their playground door so that they can hear if a child tries to open the door, and will ensure that children are not left unsupervised. LPA will conduct a Plan Of Correction visit.
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This requirement was not met as evidenced by: LPA observed a child go in from the playground without staff knowledge. LPA walked the child over to another staff member inside the facility, and child stayed with staff indoors until another staff came in to help, which poses an immediate health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
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