Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093608582
Report Date: 01/19/2017
Date Signed 01/19/2017 01:22:20 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: 0DATE:
01/19/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Amy DodgeTIME COMPLETED:
01:30 PM
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# 3LPA Patrice Terry and LPM Monica Filice met with site director Amy Dodge for the purpose of an annual random visit. LPA toured the building including all activity and classroom spaces, restrooms, food service and outdoor play areas. Appropriate ratio, care and supervision were observed during the visit. Designee was reminded never to exceed the conditions, limitations and capacity specified on the license.

Medications, toxic and hazardous items are appropriately stored and inaccessible to children. Furniture and equipment was appropriate and in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with materials to absorb the fall. Toileting facilities are in safe and sanitary condition. The food preparation space is free of litter. All food was protected against contamination. Trash cans containing solid waste had lids. Uncontaminated drinking water was readily available to children both indoors and outdoors. Menus were posted. Sign in and out sheets consisted of full legal signatures. Incidental Medical Services-IMS was discussed. Designee was advised to review the CCC EM Policy 101173 for additional information regarding IMS.

Each child has a separate and complete file. Staff personnel record was reviewed for educational background, training and experience, health screening and immunization's. At least one staff member present today has a current Pediatric CPR and First Aid certification. All staff currently employed with the facility have a criminal record clearance. There are no firearms or bodies of water on the premises. The center has a fire panel and will submit verification that carbon monoxide monitoring is included. LPA reviewed the Departments inspection authority and discussed with designee 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.
SUPERVISOR'S NAME: Monica FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Patrice TerryTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2017
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: KINDERCARE LEARNING CENTER - PARK (SA)
FACILITY NUMBER: 093608582
VISIT DATE: 01/19/2017
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The facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for a period of 30 days for parental review. Director was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of this form.


Notice of site visit was posted and must remain posted for thirty days. No deficiencies cited during this visit.
SUPERVISOR'S NAME: Monica FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Patrice TerryTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2017
LIC809 (FAS) - (06/04)
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