Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620058
Report Date: 08/02/2017
Date Signed 08/02/2017 04:14:48 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:CARL SUNDAHL ELEMENTARY SCHOOL-MONTESSORI PROGRAMFACILITY NUMBER:
343620058
ADMINISTRATOR:HIMMRICH, MONIKAFACILITY TYPE:
850
ADDRESS:9932 INWOOD ROADTELEPHONE:
(916) 294-2425
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:25CENSUS: 0DATE:
08/02/2017
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Monika HimmrichTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) Deena Chavez and Kristal Goodell met with the director Monika Himmrich for a case management licensee initiated inspection. Facility is relocating program to another room (Room #3) located on the Carl H. Sundahl Elementary campus. The portable, Room #21 is no longer in use by facility.

Facility operates Monday-Friday 8:25 am to 12:06pm during the Folsom Cordova Unified School District (FCSD) academic calendar year. FCSD resumes back to school on 8/10/17. Currently, the school site is undergoing renovations which are anticipated to be completed by 8/10/17.



LPAs toured facility to conduct a health and safety inspection and obtain room measurements.

Room #3 measured a total of 964.84 square feet.

This will accommodate a maximum of 25 preschool children. LPAs observed 2 water fountain and 2 sinks in the classroom. Preschool children will have access to a bathroom located inside the classroom. Additionally, bathrooms will be shared by campus school age children. A waiver is on file to allow preschool children to use campus bathroom and is still in effect. A functioning carbon monoxide detector was observed to meet regulation.

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SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Deena ChavezTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2017
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: CARL SUNDAHL ELEMENTARY SCHOOL-MONTESSORI PROGRAM
FACILITY NUMBER: 343620058
VISIT DATE: 08/02/2017
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LPAs observed outdoor play space. Some renovations are being made to the outdoor play area. The play structure was already in existence. Shade will be provided by the overhang outside room and 2 water fountains were observed to be not functioning at this time. Outdoor play space will be shared by school campus children. A waiver is on file to allow preschool children to use outdoor play space at differently scheduled times and is still in effect.

The following will need to completed prior to the room change approval:

Fire clearance
Submit picture of room set up and required postings
Submit picture of functioning water fountains outside

LPAs reviewed and discussed this report with director. No deficiencies issued during inspection. Notice of Site to be posted for 30 days.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Deena ChavezTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2017
LIC809 (FAS) - (06/04)
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