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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340321380
Report Date: 11/29/2023
Date Signed: 11/29/2023 11:32:42 AM

Document Has Been Signed on 11/29/2023 11:32 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PETER BURNETT PRESCHOOLFACILITY NUMBER:
340321380
ADMINISTRATOR:MAI VANGFACILITY TYPE:
850
ADDRESS:6032 36TH AVE. RM.#3TELEPHONE:
(916) 277-6522
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY: 24TOTAL ENROLLED CHILDREN: 23CENSUS: 17DATE:
11/29/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gulalai ShetabTIME COMPLETED:
11:45 AM
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On Wednesday, November 29, 2023, Licensing Program Analyst (LPA) Amanda Sutter met Site Supervisor Gulalai Shetab for the purpose of an unannounced required annual inspection. LPA observed 17 children supervised by four staff and one parent volunteer. All individuals subject to criminal background review have obtained a criminal record clearance. The facility hours of operation are Monday through Thursday from 8:00 AM to 2:30 PM, and Friday from 8:00 AM to 11:45 PM.

LPA toured classroom space, restrooms, and outdoor play area. LPA observed the following documents are posted: License, Parents' Rights Poster, Child personal Rights, Seat Belt Law, Menu, Daily Schedule, Earthquake Preparedness Checklist, Insufficient Outdoor Space Waiver, and Emergency Disaster Plan. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. The provides breakfast, lunch, and a snack.

LPA observed trash bins with tight fitted lids. The facility uses both electronic and paper sign in and out system. Facility has record of conducting fire drills at least every six months. The last fire drill was conducted on October 19, 2023. Playground equipment and surfaces are free of loose or sharp parts, and bark is present under the equipment to provide sufficient cushioning. There are sufficient equipment and toys, and shaded areas are supplied by awnings. Drinking water is readily available to children both indoors and outdoors. Director stated that children use drinking fountains but are also provided cups.

Facility representative to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

Four staff and four children's records were reviewed. Both children’s files and staff files were observed to be complete. There is at least one staff member present with a current CPR certificate.

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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: PETER BURNETT PRESCHOOL
FACILITY NUMBER: 340321380
VISIT DATE: 11/29/2023
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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, 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.

Facility representative was informed of the MyChildCarePlan.org website; 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.

During today’s inspection, no deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Site Supervisor Gulalai Shetab.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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