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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343605736
Report Date: 08/23/2023
Date Signed: 08/23/2023 11:19:48 AM

Document Has Been Signed on 08/23/2023 11:19 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:COTTAGE STATE PRESCHOOLFACILITY NUMBER:
343605736
ADMINISTRATOR:ROBINSON, KIMFACILITY TYPE:
850
ADDRESS:2221 MORSE AVENUETELEPHONE:
(916) 575-2306
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 15DATE:
08/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Kim RobinsonTIME COMPLETED:
11:35 AM
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On August 23, 2023 at approximately 9:55 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Director Kim Robinson for the purpose of an unannounced annual random inspection. LPA observed care and supervision of 15 preschool children by three staff and the Director. The facility has a maximum capacity of 26. The facility hours of operation are Monday through Friday from 8:30 AM to 3:00 PM.

LPA toured the classroom, restroom, office area, and outdoor play area. Director stated there are no firearms on the premises. 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 and the ground below the play structure is sufficiently padded. Restrooms are in sanitary condition with functioning toilets. The floors were clean throughout the facility. Medications are stored out of children’s reach and labeled according to regulation.

LPA observed that solid waste containers were covered. Per Director, the facility provides breakfast and lunch prepared by the school daily and menus are posted. Drinking water was readily available to children both indoors and outdoors. LPA observed an electronic sign in and out device near the entrance.

All present staff files were reviewed. LPA observed a current Mandated Reporter certificate which will expire March 14, 2025 and current CPR and First Aid certificate which will expire March 13, 2025.

LPA reminded Director to ensure that parents are completing all children’s forms to be kept on file in the facility. LPA observed a current facility roster and fire drill log. LPA observed first aid equipment, functioning smoke and carbon monoxide detectors, and a fully charged fire extinguisher meeting regulation. Required documents were posted.

Report continues on LIC809-C…

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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: COTTAGE STATE PRESCHOOL
FACILITY NUMBER: 343605736
VISIT DATE: 08/23/2023
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LPA discussed Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Director was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.

No deficiencies were cited based on today’s inspection. Exit interview was conducted and report was reviewed with the Director. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC809 (FAS) - (06/04)
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