343616736-9-23-2024-03-CC-ASUR-D9DKP9-20240923080422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616736
Report Date: 09/20/2024
Date Signed: 09/23/2024 08:04:50 AM

Document Has Been Signed on 09/23/2024 08:04 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:	CALVARY CHRISTIAN PRESCHOOL		FACILITY NUMBER:	343616736
ADMINISTRATOR/ DIRECTOR:	ARRIAGA, SUSAN		FACILITY TYPE:	850
ADDRESS:	4911 47TH AVENUE		TELEPHONE:	(916) 393-3633
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95824
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 40	CENSUS: 20	DATE:	09/20/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Susan Arriaga		TIME VISIT/ INSPECTION COMPLETED:	03:45 PM

NARRATIVE

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On Friday, September 20, 2024, Licensing Program Analyst (LPA) Amanda Sutter met with Director Susan Arriaga for the purpose of an unannounced required annual inspection. Upon arrival, LPA observed 9 children supervised by two staff in the toddler classroom and 11 children supervised by one staff in the preschool classroom. All individuals subject to criminal background review have obtained a criminal record clearance. The facility hours of operation are Monday through Friday, 6:00 AM to 6:00 PM.

LPA toured classroom space and outdoor play area. LPA observed the following documents are posted: License, Parents' Rights Poster, Child Personal Rights, Seat Belt Law, Menu, Earthquake Preparedness Checklist, and Emergency Disaster Plan. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. The provides breakfast, lunch, and a snack.

LPA observed trash bins with tight fitted lids. The facility uses an electronic sign in and out system. Facility has record of conducting fire drills at least every six months. The last fire drill was conducted on September 20, 2024. Playground equipment and surfaces are free of loose or sharp parts, and rubbered turf covered with astroturf is present under the equipment to provide sufficient cushioning. There is sufficient equipment and toys, and shaded areas are supplied by shade cloth and the building. Drinking water is readily available to children both indoors and outdoors. The facility purchases water jugs which are used to fill up cups.

Three staff and four children's records were reviewed. Both children’s files and staff files were observed to be complete. There is at least one staff member present with a current CPR certificate.

LPA referred Director to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

PAGE 1. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

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: CALVARY CHRISTIAN PRESCHOOL	FACILITY NUMBER: 343616736
	VISIT DATE: 09/20/2024

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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

For IMS information see PIN 22-02-CCP. 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/.

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.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During today’s inspection, one Type B deficiency was observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Susan Arriega. Appeal rights were provided.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/23/2024 08:04 AM - It Cannot Be Edited

Created By: Amanda Sutter On 09/20/2024 at 02:58 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: CALVARY CHRISTIAN PRESCHOOL	FACILITY NUMBER: 343616736
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 3 files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	LPA will return to review completed staff files.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Seychelle De Luca

LICENSING EVALUATOR NAME:

Amanda Sutter

LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024

LIC809 (FAS) - (06/04)

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