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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343601824
Report Date: 05/14/2024
Date Signed: 05/14/2024 02:48:27 PM

Document Has Been Signed on 05/14/2024 02:48 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:JAMES MARSHALL STATE PRESCHOOLFACILITY NUMBER:
343601824
ADMINISTRATOR/
DIRECTOR:		SJOLUND, ROXANEFACILITY TYPE:
850
ADDRESS:9525 GOETHETELEPHONE:
(916) 395-4607
CITY:SACRAMENTOSTATE: CAZIP CODE:
95827
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 5DATE:
05/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Roxane SjolundTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On May 14, 2024, Licensing Program Analyst (LPA) Amanda Sutter met with Site Supervisor Roxane Sjolund for a case management inspection to discuss the unusual incident report (UIR) that was reported and submitted on May 13, 2024. LPA observed 5 children supervised by 2 staff and 1 volunteer.

On 5/13/2024, a child was playing on the playground and broke their arm on the slide. LPA made observations of the playground and interviewed staff. LPA observed the play structure to be age appropriate and safe for children. Site Supervisor stated that the facility recently got new bark, and LPA observed a sufficient amount of bark to support a fall. A parent volunteer was situated with her body facing the slide, but Site Supervisor stated that the parent volunteer had said that she did not see the incident.

No deficiencies were cited in today’s visit.

Exit interview was conducted with Site Supervisor Roxane Sjolund and notice of site visit was posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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