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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310306371
Report Date: 08/24/2023
Date Signed: 08/24/2023 10:30:12 AM

Document Has Been Signed on 08/24/2023 10:30 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:KIDZCOMMUNITY - CLIPPER GAP HEAD START (PS)FACILITY NUMBER:
310306371
ADMINISTRATOR:RAMEY FAHRNEYFACILITY TYPE:
850
ADDRESS:15820 APPLEGATE ROADTELEPHONE:
(530) 878-1600
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 22DATE:
08/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ramey FahrneyTIME COMPLETED:
10:45 AM
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On 08/24/2023 at approximately 08:35AM Licensing Program Analyst (LPA) Michelle Perez arrived on property. LPA initially met with staff transportation driver. At approximately, 9am, LPA met with Ramey Fahrney for an unannounced inspection, toured the facility both inside and outside. LPA observed a cenus of 2 preschool age children with 4 staff. Facility hours of operation are Monday through Friday 08:00am to 2:30pm.

LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items are inaccessible to children. Furniture and equipment are in operable and safe condition. Playground equipment and surfaces are free of loose or sharp parts, adequate cushioning was observed in areas underneath climbing equipment, and adequate shading provided. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. Storage containers with solid waste have tight-fitting covers in each classroom. Menus were posted for AM/PM snack and lunch, which is prepared by facility. Drinking water was readily available to children both indoors and outdoors via large jug. Medications are appropriately stored and inaccessible to children and are not expired. Facility uses full legal signatures for sign in/sign out records.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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: KIDZCOMMUNITY - CLIPPER GAP HEAD START (PS)
FACILITY NUMBER: 310306371
VISIT DATE: 08/24/2023
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Children records were reviewed, it was observed that each child's file contained appropriate documentation. Staff records were reviewed for all present staff. At least one staff member present today has current Pediatric CPR and First Aid certification which expires 08/2025. All staff currently employed with the facility have complete files including a criminal record clearance, a health screening report, immunization records, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience. Mandated Reporter is current for all staff.

Incidental Medical Services (IMS) policy was discussed and is being provided. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. LPA observed medication that was not expired and properly stored.

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.

LPA informed the Director about Assembly Bill 2370, which will require certain licensed Child Care Facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1, 2023.



LPA encouraged the Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, regulations, and legislation pertaining childcare centers. LPA also encouraged the Director to sign up for the Child Care Advocates quarterly newsletter.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KIDZCOMMUNITY - CLIPPER GAP HEAD START (PS)
FACILITY NUMBER: 310306371
VISIT DATE: 08/24/2023
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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.

Based on today’s inspection, no title 22 Deficiencies are being cited.

This report was reviewed with Director, Ramey Fahrney.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC809 (FAS) - (06/04)
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