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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614545
Report Date: 06/28/2023
Date Signed: 06/30/2023 01:38:13 PM

Document Has Been Signed on 06/30/2023 01:38 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:SHALOM PRESCHOOLFACILITY NUMBER:
343614545
ADMINISTRATOR:STACEY WORTHENFACILITY TYPE:
850
ADDRESS:2320 SIERRA BLVD.TELEPHONE:
(916) 485-4151
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 173TOTAL ENROLLED CHILDREN: 173CENSUS: 39DATE:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Jillian Bar-Or and Stacy SpectorTIME COMPLETED:
11:05 AM
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On June 28, 2023 at approximately 8:55 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Head of School Jillian Bar-Or and Advancement Director Stacy Spector for the purpose of an unannounced annual random inspection. LPA observed care and supervision of 39 preschool children by 17 staff. The facility has a maximum capacity of 173. The facility hours of operation are Monday through Friday from 7:30 AM to 6:00 PM.

LPA toured the classrooms, restrooms, and outdoor play areas. Head of School stated there are no firearms on the premises. Toxic and hazardous items are locked and 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 structures is sufficiently padded. Restrooms are in sanitary condition with functioning toilets. The floors were clean throughout the facility.

LPA observed that solid waste containers were covered. Drinking water was readily available to children both indoors and outdoors. LPA observed tablets and posted QR codes for electronic sign in and sign out.

Staff files were reviewed and found to be complete. LPA observed current Mandated Reporter certificates in each staff file and at least one current CPR and First Aid certificate which will expire September 11, 2024.

LPA observed the sample of children’s files contained the appropriate documents. LPA observed complete children’s roster and fire drill log last updated May 23, 2023. LPA observed first aid equipment, smoke and carbon monoxide detectors, pull alarms, and fully charged fire extinguishers 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: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2023
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: SHALOM PRESCHOOL
FACILITY NUMBER: 343614545
VISIT DATE: 06/28/2023
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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

Head of school 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 Head of School. 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: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC809 (FAS) - (06/04)
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