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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614545
Report Date: 07/13/2022
Date Signed: 07/13/2022 12:28:43 PM

Document Has Been Signed on 07/13/2022 12:28 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SHALOM PRESCHOOLFACILITY NUMBER:
343614545
ADMINISTRATOR:STACEY WORTHENFACILITY TYPE:
850
ADDRESS:2320 SIERRA BLVD.TELEPHONE:
(916) 485-4151
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 59DATE:
07/13/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Stacey WorthenTIME COMPLETED:
12:35 PM
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On July 13, 2022 at approximately 9:05 AM Licensing Program Analyst (LPA) Josiah Gathing met with Director Stacey Worthen at the facility for the purpose of a licensee initiated case management inspection. During today’s inspection there were 59 children in care supervised by 19 teachers. Director Worthen is requesting to add Dagim classroom and increase the maximum capacity from 126 to 180 preschool children. LPA received the required fire clearance dated 03/24/2022 for the new classroom approving up to 15 preschool children.

LPA measured Dagim classroom. The total square footage of the classroom is 820.9 square feet. LPA also measured Chaverim classroom to update the previous tele-inspection measurement dated 08/25/2020. The total square footage of the Chaverim room is 954.23 square feet.

LPA used the prior indoor space measurement from the 08/01/2019 report. There is a total of 7135.3 square feet, which is sufficient for Director's request of 180 children. There are 12 toilets and 24 sinks for children’s use throughout the facility. There is a separate staff restroom. The Dagim classroom is equipped with child size furnishings. There are individual cubbies for storing children's personal belongings. There is a kitchen to support the food service on site. Morning and afternoon snacks are provided. Parents provide lunches. Drinking water is available indoors and outdoors. Children who become ill during the day will be isolated in the sick room/office and will use the sick room restroom in the main office, if necessary.



LPA did not measure outdoor space. LPA used the outdoor space measurement from the 8/18/2015 report. There is a total of 13,010 square feet, which is sufficient for 173 children. Director will submit a waiver request stating that no more than 173 children will be outside on the premises at once.

Pending waiver request approval, LPA will grant the requested capacity of 180 preschool children. An exit interview was conducted, and a Notice of Site Visit was posted. No deficiencies were cited at today’s visit.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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