343622586-8-12-2021-03-CC-GSIH-C5TUPX-20210812154617

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622586
Report Date: 08/12/2021
Date Signed: 08/12/2021 03:46:22 PM

Document Has Been Signed on 08/12/2021 03:46 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:	GOOD SHEPHERD PRESCHOOL		FACILITY NUMBER:	343622586
ADMINISTRATOR:	PHAL, SARA		FACILITY TYPE:	850
ADDRESS:	3040 ARDEN WAY		TELEPHONE:	(916) 483-0466
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 0	CENSUS: 8	DATE:	08/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Michaela Saeteurn & Sara Phal		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Gagandeep Singh met with Assistant Director, Michaela Saeteurn, for a random annual inspection. Director, Sara Phal, arrived at the facility during the inspection. Purpose of the inspection was explained. Present, there are eight children in care with assistant director. Facility is operating with in the capacity and in compliance with staff child ratio on this day. Facility operate day care from Monday to Friday between 7:30 AM to 5 PM. During today’s inspection, LPA inspected the day care areas: Main Classroom, Bathroom, Kitchen area, Dining area, another classroom and Play yard. 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 has sufficient amount of sleeping matts. Facility floor is in good repair and free of any hazards. All toilets and hand washing facilities are in working condition with proper sanitation in place. LPA observed facility has diaper change log and is in use. All storage containers for solid waste and in good repair and have proper lid on top. Facility has drinking water available for children. All the food is stored in properly manner and has lid to avoid any contamination. Food preparation area is free of litter. LPA observed allergy list posted on the refrigerator. During inspection, LPA observed the staff was wearing the face mask. At LPA’s arrival, all children were sleeping and were located al least six feet apart from each other. LPA reminded the director all staff and children are required to wear mask due to county guidelines. Play yard is free of hazards. All of the play structures are 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. Play structure is in the shaded area. LPA observed sand box being covered with tarp. See next page for continuation ...................

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GOOD SHEPHERD PRESCHOOL	FACILITY NUMBER: 343622586
	VISIT DATE: 08/12/2021

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LPA reviewed the facility records. LPA observed that facility has sign in / out record with full legal signatures. Facility has well maintained roster available on site. LPA reviewed all present children's and staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Facility has record of each child’s immunization on file. Assistant director has record of valid CPR card until August 2022 in file. There are menus posted at least one week in advance and are visible to the child's authorized representative.

LPA reminded the director that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles. Facility has record of immunization of the staff present today.

The director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Present staff have completed the training and certificates are in file.

LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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