Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093608582
Report Date: 11/10/2015
Date Signed 11/10/2015 04:34:57 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:KINDERCARE LEARNING CENTER - PARK (SA)FACILITY NUMBER:
093608582
ADMINISTRATOR:DODGE, AMYFACILITY TYPE:
840
ADDRESS:3959 PARK DR.TELEPHONE:
(916) 939-0391
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:28CENSUS: 12DATE:
11/10/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Robin PerleTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Nicole Davis advised the assistant director, Robin Perle of today's annual, random inspection. The center operates from 6:30am - 6:00pm, Monday through Friday. 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, drinking water and food service provisions.

LPA observed all required forms posted including the facility license, food service menu that meets regulation, personal rights form, parents' rights' poster, emergency care, disaster plan and seat belt law. LPA reviewed incidental medical services, the sign/in-sign/out sheets, children's’ and personnel records. All staff currently employed with the center have criminal record clearances. At least one staff member present today has current Pediatric CPR and First Aid.

This facility provides Incidental Medical Services-IMS. LPA reviewed the storage of medication and equipment and supplies, and reviewed children’s, personnel, and administrative records. LPA discussed the need to update the centers plan of operation to reflect IMS plan. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173. LPA reviewed Departments inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in director's absence must be reported to department within 10 working days. LPA conducted an exit interview and advised her of the Notice of Site Visit posting requirement and must be posted for the next 30 days. LPA also provided the Licensing Agency website (www.ccld.ca.gov), so the director and/or staff may obtain updated licensing information, regulations, and forms.

No Title 22 violations are being cited during today's visit.
SUPERVISOR'S NAME: Monica FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Nicole DavisTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2015
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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