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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318294
Report Date: 06/08/2022
Date Signed: 06/08/2022 03:08:30 PM

Document Has Been Signed on 06/08/2022 03:08 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SMYTHE STATE PRESCHOOLFACILITY NUMBER:
340318294
ADMINISTRATOR:WALKER, DAWNFACILITY TYPE:
850
ADDRESS:2781 NORTHGATE BLVD., ROOM #1TELEPHONE:
(916) 263-8466
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 7DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Ben KwanTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Michelle Pascual met with Head Teacher Ben Kwan for the purpose of an unannounced annual random inspection. Census included 7 preschool children and three staff members in Room 1. Due to summer break, room 40 is not utilized by Smythe. Room 40 it was being utilized by Strauch Elementary Preschool. Teacher on Special Assignment (TOSA), Lena Saunders arrived during the inspection to provide staff files. Facility hours of operation are Monday through Friday 7:00 AM to 5:00 PM in Room 1.

LPA toured the classroom, restrooms, and outdoor play area. Head Teacher stated there are no poisons on the premises. Medications, 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 areas around or under climbing equipment are cushioned with artificial turf to absorbs falls.

LPA observed CPR for head teacher expiring on 10/2023 and Mandatory reporter certificates for all staff expiring on 04/2024 and 08/2023.

Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. Storage containers with solid waste have tight-fitting covers. Full day program provides breakfast, lunch, and supper and part day program provides lunch for both sessions. Food is prepared by the school's cafeteria. Menus were posted and drinking water was readily available to children both indoors and outdoors.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
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: SMYTHE STATE PRESCHOOL
FACILITY NUMBER: 340318294
VISIT DATE: 06/08/2022
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All staff currently employed with the facility have a criminal record clearance through the school district and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector, which is hardwired into the fire alarm system. LPA and TOSA discussed updating the personnel roster with new teacher information.

Incidental Medical Services (IMS) policy was discussed. Currently IMS is not being provided. 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.

LPAs observed Effects of Lead Exposure brochure is posted. LPAs provided new immunization card.

This facility evaluation report was reviewed and discussed with TOSA. TOSA was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC809 (FAS) - (06/04)
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