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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313610174
Report Date: 10/10/2024
Date Signed: 10/10/2024 02:17:30 PM

Document Has Been Signed on 10/10/2024 02:17 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:S.T.A.R. CREEKSIDE OAKSFACILITY NUMBER:
313610174
ADMINISTRATOR/
DIRECTOR:		SANDOVAL, MARISAFACILITY TYPE:
840
ADDRESS:2030 FIRST STREETTELEPHONE:
(916) 434-8085
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
10/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Ellen DerkachTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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On Thursday, October 10, 2024, Licensing Program Analysts (LPA) Lea Habtom met with designated staff Ellen Derkach for the purpose of a required annual inspection. The facility is located on Creekside Oaks Elementary School. Upon arrival there were 3 transitional kindergarten children. Around 1:40 pm 5 kindergarten children were picked up. There were 8 children being supervised by 3 staff and the site supervisor in room #28. All criminal record clearances are associated to facility #313600444.

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 is licensed for room #28. Medications were reviewed. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. The facility shares the playground and restrooms located on the school campus. Playground equipment and surfaces are free of loose or sharp parts. The floors appeared clean throughout the facility. All food was protected against contamination. Children bring their own snacks and the facility has extra snacks if needed. Drinking water was readily available to children both indoors and outdoors by personal labeled water bottles and a water fountain. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. Staff and children's records were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA reviewed the Department's inspection authority and discussed 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 continued on 809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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: S.T.A.R. CREEKSIDE OAKS
FACILITY NUMBER: 313610174
VISIT DATE: 10/10/2024
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Incidental Medical Services (IMS) policy was discussed. 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. 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

Staff are encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

No Title 22 Deficiencies were cited during today's inspection. Exit interview conducted and report was reviewed with the facility representative Ellen Derkach. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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