343609470-9-28-2023-03-CC-GSIH-CW4QRZ-20230928122447

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343609470
Report Date: 09/28/2023
Date Signed: 09/28/2023 12:25:01 PM

Document Has Been Signed on 09/28/2023 12:25 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:	GOLDEN EMPIRE PRESCHOOL		FACILITY NUMBER:	343609470
ADMINISTRATOR:	STEET, MARILYN		FACILITY TYPE:	850
ADDRESS:	9045 CANBERRA DR.		TELEPHONE:	(916) 228-5890
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95826
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 20	DATE:	09/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Maria Avetisov		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Gagandeep Singh met with site supervisor, Maria Avetisov, for an annual inspection. Purpose of the inspection was explained. Present, there are 20 children in care with three staff and the site supervisor. Facility is operating with in the capacity and in compliance with staff child ratio on this day. Facility operates at school site in classroom A3 from Monday to Thursday between 8 AM to 2:30 PM and on Friday between 9 AM to 11:45 AM. With Site supervisor, LPA inspected the day care classroom and play yard. LPA observed facility has smoke detector, carbon monoxide detector, fully charged fire extinguisher and working telephone at the site. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. All toilets, hand washing facilities are in working condition with proper sanitation in place. Facility has drinking water available for children. During the inspection, staff took children to the play yard. LPA observed play yard is free of hazards. Play structure is steady, in good repair and free of any loose parts. There is sufficient amount of wood chips under the play structures to prevent any fall injuries. There are trees in the play yard providing shaded area for the children. There is drinking water fountain in the play yard and staff brings water cups for the children. LPA observed facility staff was stationed at different parts of the play yard and provided proper supervision. During inspection, LPA reviewed the facility records. LPA observed that facility has sign in / out record with full legal signatures. Facility has menu posted next to the sign in/ out. Facility has license and all of the other required documents posted next to the entrance door and are visible for public. Facility has conducted the fire drill log in place. Per log, last drill was conducted on September 28, 2023. See next page for continuation .............

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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: GOLDEN EMPIRE PRESCHOOL	FACILITY NUMBER: 343609470
	VISIT DATE: 09/28/2023

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LPA reviewed random children's and all staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Multiple staff members has record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers. All staff has record required immunization on file.

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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. 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). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information

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/.

No deficiencies were cited during today's inspection. Copy of this report was reviewed and provided to the facility representative, Maria Avetisov. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC809 (FAS) - (06/04)

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