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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621978
Report Date: 08/17/2023
Date Signed: 08/17/2023 03:19:21 PM

Document Has Been Signed on 08/17/2023 03:19 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:STAR CARLIN C. COPPINFACILITY NUMBER:
313621978
ADMINISTRATOR:ASHLEIGH WEATHERLYFACILITY TYPE:
840
ADDRESS:150 E. 12TH STREETTELEPHONE:
(916) 632-8407
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 26DATE:
08/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Kristina FiffickTIME COMPLETED:
03:25 PM
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On August 17, 2023 Licensing Program Analyst (LPA) Lea Habtom arrived to the STAR Carlin C Coppin Elementary school campus and meet with designated staff member Kristina Fiffick for a required annual inspection. At the time of arrival, there were 26 children present being supervised by 3 staff. The school is closed in the summer and re-opens in the fall. The facility is located in portable room K. All criminal record clearances are associated to the STAR Oakhills #313600444. Facility hours of operation are Monday through Friday from 11:20am - 6pm.

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.

LPA toured the classroom, restroom, and outdoor play area. The facility utilizes the school play ground and restrooms. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The floors appeared clean throughout the facility. Drinking water was readily available to children both indoors and outdoors. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. 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: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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: STAR CARLIN C. COPPIN
FACILITY NUMBER: 313621978
VISIT DATE: 08/17/2023
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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 Center Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 513-0301 (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.ht

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.

There were no Title 22 Deficiencies cited during today's inspection.


Exit interview conducted and report was reviewed with Kristina Fiffick. 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: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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