<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614437
Report Date: 06/08/2023
Date Signed: 06/08/2023 12:49:36 PM

Document Has Been Signed on 06/08/2023 12:49 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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KOHLER PRESCHOOLFACILITY NUMBER:
343614437
ADMINISTRATOR:BRITTANY GARRETTFACILITY TYPE:
850
ADDRESS:4004 BRUCE WAYTELEPHONE:
(916) 566-1850
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 11DATE:
06/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Brittany GarrettTIME COMPLETED:
01:00 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
On June 8, 2023 at 11:45 AM, Licensing Program Analysts (LPAs) Tanya Washington and Eddie Barragan met with Facility Representative (FR) Brittany Garret for an unannounced case management inspection regarding a self reported unusual incident which occurred on 05/04/2023. Upon arrival LPAs observed care and supervision of 11 children in care of three staff. During today's inspection LPAs conducted staff interviews and made observations.

On May 9, 2023 Facility self reported that on 05/04/2023, Child #1 ran out of the full day classroom and was located by the elementary school counselor near the classroom. Staff interviews indicated that they did not see Child #1 exit the room, however the child was without supervision for less than one minute. When staff was informed that one of their students was out on the courtyard Staff #1 and #2 ran after the child and returned them back to class safely.

Since the incident facility has installed a chime on the door to alert staff when the door opens. Going forward a staff member will be positioned near the entrance door to ensure no children leave the classroom without adult supervision.

Upon receipt, facility representative shall post and provide copies of this licensing report to parents/ guardians of children who are currently enrolled as well as parents/ guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must acknowledge receipt of this report and citation by signing a LIC9224, “ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS”. A copy of this form should be placed in each child file upon receipt from parent.

Refer to LIC809D for citation information.

LPA discussed this report with facility representative and conducted an exit interview. LPA also provided appeal rights. Notice of site visit posted.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 06/08/2023 12:49 PM - It Cannot Be Edited


Created By: Tanya Washington On 06/08/2023 at 12:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KOHLER PRESCHOOL
FACILITY NUMBER: 343614437

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/08/2023
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility has installed a chime at the door to alert them when the door opens. Staff will also be positioned near the front door so no children are able to exit the room without teachers knowledge.
8
9
10
11
12
13
14
Interviews conducted and facility self reporting that Child #1 exited the classroom without staff knowledge. Child #1 was observed outside by a school counselor who alerted staff inside the class. This is an immediate health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Amanda Blesi
LICENSING EVALUATOR NAME:Tanya Washington
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2