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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343626857
Report Date: 07/07/2025
Date Signed: 07/07/2025 05:07:18 PM

Document Has Been Signed on 07/07/2025 05:07 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 SCHOOLFACILITY NUMBER:
343626857
ADMINISTRATOR/
DIRECTOR:		SHALOM SCHOOL PSFACILITY TYPE:
860
ADDRESS:2320 SIERRA BLVDTELEPHONE:
(916) 485-4151
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 173TOTAL ENROLLED CHILDREN: 173CENSUS: 87DATE:
07/07/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sasha BlahaTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On July 7, 2025, at approximately 9:00 AM Licensing Program Analysts (LPAs) Julia Maryanova and Josiah Gathing met with Preschool Coordinator, Sasha Blaha for the purpose of an announced pre-licensing inspection to add a Toddler Age component and convert to a Single License facility. Applicant requests a preschool license with a toddler component to serve 158 preschool children from ages 2 to 5 and 15 toddler children from age of 18 months old to 3 years old. LPAs observed a census of 87 preschool school and pre-k age children being supervised by 21 staff. The program hours of operation are Monday through Friday, 07:30 AM to 6:00 PM. The fire clearance was granted on April 7, 2025.

Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, Effects of Lead Exposure brochure, menus, and daily schedule. LPAs discussed the forms that must be in each child's file and each staff member's file. The facility will provide AM snack and PM snacks. Parents will provide lunch.



INDOOR ACTIVITY SPACE:

There are 8 classrooms. LPAs observed a sufficient amount of equipment, toys, chairs, and tables. There are first aid kit supplies, fully charged fire extinguishers, and trash cans with lids. Applicant stated medications will be stored in the nurses office with labels and epi pens are in the classroom. Applicant stated there are no smoking or no poisons on the premises. LPAs observed daily electronic sign in and sign out app, ProCare. Facility utilizes armed guard services which was previously approved by Licensing and has submitted a new waiver request.

Page 1. Report continues on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Julia Maryanova
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 SCHOOL
FACILITY NUMBER: 343626857
VISIT DATE: 07/07/2025
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LPAs measured the all 8 classrooms. The total indoor space contained a total of 7077.63 square feet, which accommodates Applicant's request for 158 preschoolers and for 15 toddlers.

There are one toilet and three sinks/hand washing fixtures for Toddler room which will accommodate the requested capacity of 15 Toddler children. There are eleven toilets and twenty sinks/hand washing fixtures for Preschool children which will accommodate the requested 158 Preschool children.

OUTDOOR SPACE:

Applicant acknowledges children must use age appropriate equipment. The outdoor play areas are enclosed by fencing that is at least four feet tall. LPAs observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees, structure and canopy.

LPAs measured the outdoor space totaling 16438.96 square feet which will accommodate the requested 158 Preschool children and 15 Toddler children. LPAs advised Applicant that a waiver must be requested for shared outdoor space. There is sufficient material under the play structures for cushioning. There were no labels at play structures. Applicant was advised to ensure play structures are age appropriate.

Indoor and outdoor water bottles or thermoses are provided by parents and filled in the facility. There is also a drinking fountain outdoors for children.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. 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

LPA discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Page 2. Report continues on 809-C

NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Julia Maryanova
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
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 SCHOOL
FACILITY NUMBER: 343626857
VISIT DATE: 07/07/2025
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Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

This facility evaluation report was reviewed and discussed with Applicant Sadie Hardin. LPAs provided copy of the LIC311A Records to be Maintained at the facility and LIC125(3/21) Entrance Checklist- Child Care Centers.



CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:

1. A final review of the file by Licensing Program Manager (LPM) Seychelle De Luca.
2. Applicant to provide LPA proof of functioning carbon monoxide detractor within facility.
3. Applicant to provide LPA waiver request for shared outdoor space.

A copy of this report was printed and provided to Preschool Coordinator, Sasha Blaha.
NAME OF LICENSING PROGRAM MANAGER: Amanda Blesi
NAME OF LICENSING PROGRAM ANALYST: Julia Maryanova
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC809 (FAS) - (06/04)
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