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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343609470
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:22:18 AM

Document Has Been Signed on 09/08/2022 11:22 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:GOLDEN EMPIRE PRESCHOOLFACILITY NUMBER:
343609470
ADMINISTRATOR:STEET, MARILYNFACILITY TYPE:
850
ADDRESS:9045 CANBERRA DR.TELEPHONE:
(916) 228-5890
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 19DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria AvetisovTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Gagandeep Singh met with site supervisor, Maria Avetisov, for an annual inspection. Purpose of the inspection was explained. Present, there are 19 children in care with three staff and the site supervisor. Facility is operating with in the capacity and in compliance with staff child ratio on this day. Facility operates at school site in classroom A3 from Monday to Thursday between 8 AM to 2:30 PM and on Friday between 9 AM to 11:45 AM.

With Site supervisor, LPA inspected the day care classroom and play yard. LPA observed 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, hand washing facilities are in working condition with proper sanitation in place. Facility has drinking water available for children. During the inspection, staff took children to the play yard. LPA observed play yard is free of hazards. Play structure is 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. There are trees in the play yard providing shaded area for the children. There is drinking water fountain in the play yard and staff brings water cups for the children. LPA observed facility staff was stationed at different parts of the play yard and provided proper supervision.

During inspection, LPA reviewed the facility records. LPA observed that facility has sign in / out record with full legal signatures. Facility has license and all of the other required documents posted next to the entrance door and are visible for public. Facility has conducted the fire drill on June 09, 2022 and has next drill scheduled on September 15, 2022. Facility has an updated children roster on file.
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SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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: GOLDEN EMPIRE PRESCHOOL
FACILITY NUMBER: 343609470
VISIT DATE: 09/08/2022
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LPA reviewed random children's and all staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Multiple staff members has record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers. There are menus posted at least one week in advance and are visible to the child's authorized representative. The facility 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. LPA observed the facility using the Department approved training and completion certificates are on file.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

All Child Care Centers (CCCs) that are located in buildings constructed before January 1, 2010 must have their drinking water tested for lead and post the results by January 1, 2023 and every 5 years after the date of the initial test. For a license issued on or after July 1, 2022, the CCC must have its water tested and post the results within 180 days of licensure.



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 [email protected] 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: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
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