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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623604
Report Date: 08/23/2021
Date Signed: 08/23/2021 11:51:32 AM

Document Has Been Signed on 08/23/2021 11:51 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CIRBY PRESCHOOLFACILITY NUMBER:
313623604
ADMINISTRATOR:DAWSON-ROBERTS, TERESAFACILITY TYPE:
850
ADDRESS:814 DARLING WAYTELEPHONE:
(530) 745-1380
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
08/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Catherine McCoy - TIME COMPLETED:
12:00 PM
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An unannounced annual/random inspection on PRESCHOOL PROGRAM is made today by Licensing Program Analyst Owens. This is an AM Program only at this time. LPA Owens met with Catherine McCoy - Associate Teacher. LPA toured the one classroom portable and outdoor play areas. Staff and child were spoken to during inspection.

The following areas are in compliance during inspection: There are no bodies of water. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted according to Title -22 Regulations. The playground equipment and outdoor activity space is maintained and in good condition. There is adequate shade on the playground. Wood chips is being used as cushioning around the climbing equipment. A Carbon Monoxide detector is on the premises. Children are escorted to use the Cirby school restrooms. Classroom is safe and clean. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered and all food or beverages are stored in covered containers at 45 degrees or less. The facility provides AM snack only. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Teacher/child ratios are maintained and adequate supervision is being provided during this inspection. There is adequate space for children belongings. Children do not nap at facility. Sign in/sign out sheets maintained. No excluded individuals are present. Criminal record clearance or exemption are monitored by Department of Education. Staff has current CPR. Staff records reviewed contain documentation of the educational background, training, and/or experience. Operating hours are Monday thru Friday; 8:00 AM to 11 AM only at this time.
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SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: CIRBY PRESCHOOL
FACILITY NUMBER: 313623604
VISIT DATE: 08/23/2021
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LPA observed proof that all staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

LPA discussed the new Safe Sleep in Child Care regulation and LPA discussed the Effects of Lead Exposure requirements.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.



Incidental Medical Services (IMS) policy was discussed, the facility is not currently providing IMS at this time. 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.

No deficiencies observed in the areas inspected during today's inspection. This report was reviewed and discussed with the facility representative at the time of the inspection.



A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
NOTICE OF SITE VISIT FORM POSTED TO PARENT'S BOARD FOR 30 DAYS.

To order forms, etc. visit our website at www.ccld.ca.gov

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC809 (FAS) - (06/04)
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