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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313628105
Report Date: 07/27/2026
Date Signed: 07/27/2026 01:21:16 PM

Document Has Been Signed on 07/27/2026 01:21 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:O'BRIEN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
313628105
ADMINISTRATOR/
DIRECTOR:		PERE, PATRICIAFACILITY TYPE:
860
ADDRESS:4035 GRASS VALLEY HWY STE KTELEPHONE:
(530) 885-0530
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY: 60TOTAL ENROLLED CHILDREN: 23CENSUS: 9DATE:
07/27/2026
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Donald KoenigTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On July 27, 2026 at approximately 10:30 AM, Licensing Program Analyst (LPA), Josiah Gathing met with Licensee Representative (LR) Donald Koenig for an announced Change of Components Pre-Licensing inspection with conversion to a Single License. LR is requesting a license for 18 infants (ages 0 to 24 months) in Infant Room 1 and Infant Room 2; 42 Preschool children (ages 2-5 years) in Preschool Kids Room 1, Preschool Kids Room 2, and Indoor Play Room. The total requested capacity is 60 children. Facility was previously licensed to serve 32 Preschool Children and 18 infants including 12 Toddlers with the Toddler Option. Areas of the facility not included in indoor activity space include the office, staff restroom, children's restrooms, supply room, kitchenette, and kitchen. Hours of operation will be: Monday-Friday 6:00am to 6:00pm. Facility previously had a waiver for children from separate age groups to share the same space during the first and last hour of operation. Licensee Representative will submit a request to maintain this waiver under the new license.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed LR that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, LR stated that they will be stored in the supply closet downstairs in a locked box, and upstairs in a locked box in the staff restroom, inaccessible to children. LPA observed first aid backpacks in the classrooms. There are operational smoke detectors, carbon monoxide detectors, and fully charged fire extinguishers in the classrooms. All required licensing documents were observed posted near the entrance. Children will be signed in and out via paper sign-in sheets.

LPA measured total indoor infant activity space of 809.754 square feet, which is sufficient to accommodate the requested capacity of 18 infants. LPA measured total indoor preschool activity space of 1,539.757 square feet, which is sufficient to accommodate the requested capacity of 42 preschool children.


Cont. on LIC809-C...

Belinda Devall
Josiah Gathing
DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: O'BRIEN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 313628105
VISIT DATE: 07/27/2026
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LPA observed all indoor activity space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, cots, cribs, bookshelves, and other activity supplies for the children. Toys are safe with no sharp edges, splinters, or points, nor made of small parts that can present a choking hazard. Drinking water is available in the classrooms via water coolers and cups provided by the facility. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. The fire department provided an approved fire clearance form to Licensing on 7/8/2026.

LPA observed four changing tables in the facility. Changing tables have at least 1” padding covered with moisture-resistant, washable material. Sides of the changing tables are at least 3” high. There are sinks within arm's reach of the changing tables. Diapering sinks are not used for meal preparation or dishwashing. The infant napping area is physically separated from the indoor activity space according to regulation. During today's inspection, there were 8 cribs meeting regulatory requirements in the infant napping area. LPA advised LR that the number of infants enrolled who require cribs must never exceed the number of available cribs in the nap area. Sleep Logs are kept on clip boards in the infant classroom with Needs and Services Plans.

There are a total of 5 toilets and 6 available for children which will be sufficient to accommodate the requested capacity of 60 children. There is a separate staff restrooms equipped with a toilet and sink. The isolation area for children who are ill is the kitchenette attached to preschool kids room 1.

Facility provides morning and afternoon snack and lunch is provided by families. Menu is posted at the front near other posted documents. There are refrigerators in the infant rooms to store milk and formula for infants. Hazardous solutions and cleaning supplies are stored in a locked cabinet in supply room.

The facility currently has three fully fenced playground areas. There are two infant playgrounds and one preschool playground. Fencing is at least four feet high. LPA measured total square footage of 528.73 for the outdoor infant activity space, which is not sufficient to accommodate the requested capacity of 18 infants. The total square footage for the outdoor preschool space is 2,471.04 which is not sufficient to accommodate the requested capacity of 42 preschoolers. Waiver requests for infants and preschoolers to utilize the outdoor activity spaces based on groups with alternating schedules shall be submitted and approved prior to licensure.


Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: O'BRIEN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 313628105
VISIT DATE: 07/27/2026
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There are sufficient outdoor toys and play equipment available on the playgrounds. LPA reminded LR to ensure that all play equipment and structures are only utilized by appropriate age groups. Drinking water is available outdoors via drinking fountains and children's containers provided by the facility.

LR was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LR was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child

LR was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: O'BRIEN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 313628105
VISIT DATE: 07/27/2026
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Exit interview conducted and report was reviewed with LR, Donald Koenig. Notice of Site visit was provided.

The following corrections are needed prior to issuance of the license:

-Waiver review and approval for first and last hour comingling.


-Waiver review and approval for alternating groups of preschool children on the playground.
-Waiver review and approval for alternating groups of infant children on the playgrounds.
-Submission of any additional requested documents.
-Final review and approval by Licensing Program Manager.

LR understands that all proof of corrections must be provided to the department within 30 days, or the application may be denied.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026
LIC809 (FAS) - (06/04)
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