313623604-5-23-2022-03-CC-KOWS-CEPLNV-20220523085459

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623604
Report Date: 05/23/2022
Date Signed: 05/23/2022 08:55:05 AM

Document Has Been Signed on 05/23/2022 08:55 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 PRESCHOOL		FACILITY NUMBER:	313623604
ADMINISTRATOR:	DAWSON-ROBERTS, TERESA		FACILITY TYPE:	850
ADDRESS:	814 DARLING WAY		TELEPHONE:	(530) 745-1380
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95678
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 5	DATE:	05/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Katherine McCoy - Site Supervisor		TIME COMPLETED:	09:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	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 Katherine McCoy - Site Supervisor. 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 is currently undergoing construction and is not being used by children at this time. 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. Facility representative, Katherine McCoy, 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. Staff subject to a criminal record clearance or exemption are associated to the facility. Continued on page 2

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

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: 05/23/2022

NARRATIVE

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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.

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 Assembly Bill 2370, which will require licensed Child Care facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testing.

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: 05/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022

LIC809 (FAS) - (06/04)

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