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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623603
Report Date: 11/08/2022
Date Signed: 11/08/2022 02:00:28 PM

Document Has Been Signed on 11/08/2022 02:00 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:SMALLVILLE PRESCHOOLFACILITY NUMBER:
343623603
ADMINISTRATOR:SHANNON NULLFACILITY TYPE:
830
ADDRESS:4706 ARDEN WAYTELEPHONE:
(916) 480-0632
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 8DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Shannon NullTIME COMPLETED:
02:15 PM
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At 10:45 a.m. on Tuesday, November 8th, 2022, Licensing Program Analysts (LPAs) Karyn Guerra and Soleil Marx met with Licensee, Shannon Null, for the purpose of an unannounced required - 1 year inspection. LPAs observed a census of 8 napping infants supervised by 2 staff. Facility hours or operation are 7:00 a.m. - 5:30 p.m., Monday thru Friday.

All individuals subject to criminal background review have obtained criminal record clearance. Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs conducted a health and safety inspection of the classroom, restrooms, and food service areas. LPAs observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat laws, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Licensee stated that there are no firearms nor poisons on the premises. LPAs observed a changing table within arm's reach of a sink. Changing table has raised sides. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. Infant food is provided by parents/guardians. LPA observed prepared milk bottles labeled with children's names and the current date. Other food in the facility was properly stored to prevent contamination. Drinking water is provided to children via labeled sippy cups. LPA observed sign in and sign out logs with full legal signature of parent/guardians.

No children in care require medications. Incidental Medical Services – IMS was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA

Report continued on 809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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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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: SMALLVILLE PRESCHOOL
FACILITY NUMBER: 343623603
VISIT DATE: 11/08/2022
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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.

LPA discussed the safe sleep regulations with licensee 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 licensee 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. Napping infants were observed in cribs without loose articles or objects. Napping logs and individual infant sleeping plans were observed with needs and services plans. A waiver is on file for infant cribs.

LPA conducted a health and safety inspection of the outdoor space. Playground equipment and surfaces were free of loose or sharp parts. LPA observed wood chips to provide cushioning. Outdoor shade was provided by trees. Water is accessible via fountain and sippy cups.

LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, immunizations, and acknowledgement of receipt of personal rights, consent for emergency medical treatment, and parent’s rights. LPA observed CPR and First aid certification for at least one staff on the facility premises. LPA observed health screening, staff immunization records, current AB 1207 Mandated Reporter training certificates, employee rights, and documentation of the educational background, training, and/or experience for some staff. Technical assistance was conducted.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, no deficiencies were cited during today’s inspection. Exit interview conducted and report was reviewed with the Licensee, Shannon Null. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC809 (FAS) - (06/04)
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