Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617176
Report Date: 01/22/2018
Date Signed: 01/22/2018 01:00:18 PM

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:SAINT JOHN THE EVANGELIST PRESCHOOLFACILITY NUMBER:
343617176
ADMINISTRATOR:WITTEBORG, AUDREYFACILITY TYPE:
850
ADDRESS:5701 LOCUST AVENUETELEPHONE:
(916) 481-8845
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:60CENSUS: 11DATE:
01/22/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Maria ChagoliaTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Emerita Curiel met with the new Site Director, Maria Chagolia for an annual/random inspection on the preschool license. There were 11 preschool children at the time of the inspection. LPA toured the facility, including all activity/classroom areas, the isolation area, food service area, restrooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications and first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions. Facility provides AM snack and PM Snack. Children bring lunch from home. Hours of Operation: Monday to Friday 7:00 am - 6:00 pm.
LPA observed all required forms and Menu were posted. Medications are stored in a cabinet inaccessible to children in care. First aid materials were available. There are adequate toys and equipment available for school age children. The restrooms were observed to be in working order.
LPA reviewed a the completed sign in and out sheets. Reviewed Children's and Personnel records. All staff present had evidence of current criminal background clearances and associations At least one staff member present today has current Pediatric CPR and First Aid exp date 10/2018.
LPA discussed recent changes in licensing requirements, including SB 277 and SB 792 pertaining to immunization requirements for children and staff. Facility provided proof of staff immunization's. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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 provided the Licensing Agency website (www.ccld.ca.gov), so the director and/or staff may obtain updated licensing information, regulations, and forms.

The facility is in substantial compliance today. Exit interview conducted. Notice of Site Visit was posted.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Emerita CurielTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2018
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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