343626857-5-1-2026-03-CC-PSEI-DTNMSH-20260501095159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343626857
Report Date: 04/29/2026
Date Signed: 05/01/2026 09:53:17 AM

Document Has Been Signed on 05/01/2026 09:53 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:	SHALOM SCHOOL		FACILITY NUMBER:	343626857
ADMINISTRATOR/ DIRECTOR:	STACEY WORTHEN		FACILITY TYPE:	860
ADDRESS:	2320 SIERRA BLVD		TELEPHONE:	(916) 485-4151
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY: 173	TOTAL ENROLLED CHILDREN: 173	CENSUS: 109	DATE:	04/29/2026
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Sasha Blaha		TIME VISIT/ INSPECTION COMPLETED:	02:15 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	On April 29, 2026, Licensing Program Analysts (LPAs) Kyrsten Williams and Payenda Seddiqi met with Facility Representative, Sasha Blaha for the purpose of an unannounced case management licensee-initiated inspection. Licensee requested to adjust capacity for toddler component. Licensee request to keep total capacity of 173 children and have 37 toddlers age 18 to 36 months under the toddler component and 136 preschool children age 2 years to 5 years. The facility's hours of operation are Monday through Friday, 07:30 AM to 6:00 PM. The fire clearance was granted on 04/14/2026. Census included 15 toddler component and 95 preschool children being supervised by 24 staff members. LPAs conducted a health and safety inspection in all areas accessible to all children. There is one existing toddler component classroom: Dagim. There are 6 existing preschool classrooms: Chaverim, Parparim, Gesher, Yonim, Dubim, Pre-K Yellow, and Pre-K Blue. The licensee requested to change the Chaverim classroom from a preschool classroom to toddler component classroom. There are no changes made to the facility or the facility’s measurements as of July 07, 2025, when last measurements were taken. The Dagim classroom contains a total of 736.06 square feet. The Chaverim classroom contains a total of 900.19 square feet. The total classroom space to be used for the toddler component contains 1,636.25 square feet, which will accommodate the requested capacity of 37 toddlers. There is 1 toilet and 1 sink available to children in the Dagim classroom. The Chaverim classroom shares a bathroom space with the Gesher classroom and contains 3 toilets separated into divided into open stalls and 2 sinks available to children. The Chaverim classroom also contains one changing table. There is a separate staff restroom that is available for staff. The total square footage for preschool classrooms is 5,441.38, which accommodates the requested capacity of 136 preschool children. *PG. 1 - Report Continues on LIC809-C.*

NAME OF LICENSING PROGRAM MANAGER: Jeevun Birk-Miller
NAME OF LICENSING PROGRAM ANALYST: Payenda Seddiqi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026

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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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: 04/29/2026

NARRATIVE

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All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard were observed to be free of obstruction. The child care center was observed to be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. Floors of all rooms have a surface that is safe and clean. Furniture and equipment were observed to be sufficient in quantity, maintained in good condition, free of sharp, loose or pointed parts. Tables and chairs were observed to meet the needs of the children. All play equipment and materials used by children were observed to be age appropriate.

LPAs observed sufficient individual permanent or portable storage space for each child’s personal belongings. All materials and surfaces accessible to children, including toys, shall be free of toxic substances. A functional carbon monoxide detector was observed in the facility.

There are 3 outdoor areas on the property designated for toddler component children: Woods playground, Back Grass playground, and Rainbow playground. The outdoor play areas are enclosed by fencing that is at least 4 feet tall. All playground equipment and surfaces were inspected and are in good condition, with enough resilient material under climbing structures to absorb a fall. Facility Representative was reminded to follow the safety labels on the playground equipment and adhere to the age rating. LPAs observed sufficient amount of equipment and toys. There are shaded areas supplied by overhangs and sunshade sales in each of the playgrounds. There are no changes made to the facility outdoor play areas as of July 7, 2025, when last measurements were taken. The 3 outdoor toddler playgrounds contain the following square footage: Woods Playground equals 2,435.63, Back Grass Playground equals 4,528.72, and Rainbow Playground equals 737.94. The total square footage of the toddler playgrounds equals 7,702.29, which will accommodate the licensee’s request for 37 toddler component children. Facility Representative was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

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.
PG. 2 - Report Continues on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Jeevun Birk-Miller
NAME OF LICENSING PROGRAM ANALYST: Payenda Seddiqi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2026

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: 04/29/2026

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Facility Representative was informed of the www.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.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Facility Representative, Sasha Blaha.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:

1. A final review of the file by Licensing Program Manager (LPM) Jeevun Birk-Miller.

NAME OF LICENSING PROGRAM MANAGER: Jeevun Birk-Miller
NAME OF LICENSING PROGRAM ANALYST: Payenda Seddiqi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2026

LIC809 (FAS) - (06/04)

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