054500363-4-5-2021-53-CC-ASIS-BZSNWB-20210405104915

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 054500363
Report Date: 04/05/2021
Date Signed: 04/05/2021 10:50:33 AM

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:	ST. PATRICK'S CATHOLIC PRE-SCHOOL		FACILITY NUMBER:	054500363
ADMINISTRATOR:	SIERRA WINSLOW SCOTT		FACILITY TYPE:	840
ADDRESS:	809 S. MAIN STREET		TELEPHONE:	(209) 736-4458
CITY:	ANGELS CAMP	STATE: CA	ZIP CODE:	95222
CAPACITY:	8	CENSUS: 0	DATE:	04/05/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kacy Barnett		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Application Specialist (AS) Alecia Sifuentes and Licensing Program Analyst (LPA) Justin Denton met with Applicant/Director, Kacy Barnett for the purpose of an announced pre-licensing inspection via FaceTime due to COVID-19. Applicant requests a school-age license to serve 8 school-age children from kindergarten and above. The program will operate Monday through Friday from 7:30 a.m. to 4:30 p.m. The fire clearance was received and granted on 3/29/2021. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat poster, menus, and daily schedule. The facility will not provide food. INDOOR ACTIVITY SPACE: There is one school-age classroom. AS observed a sufficient amount of equipment, tables, chairs, and hooks. There is a first aid kit located in a locked closet in the classroom. Medications will be stored in a locked supply closet located in the preschool classroom. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated parents will provide water bottles and water pitchers will be available in the classroom. AS observed a functional carbon monoxide detector in the classroom. AS observed sign-in/sign-out binders. Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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: ST. PATRICK'S CATHOLIC PRE-SCHOOL	FACILITY NUMBER: 054500363
	VISIT DATE: 04/05/2021

NARRATIVE

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AS measured one classroom. The total classroom space contains a total of 784 square feet, which will accommodate Applicant's request for 8 school-age children. There are 3 toilets and 3 sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor area will be shared with the preschool children. Applicant has requested a Shared Playground Waiver. Applicant provided outside classroom schedules showing no co-mingling between the age groups. The outdoor play area is fenced with a chain link fence that is at least four feet tall. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees and a canopy.

AS measured the outdoor activity space. The outdoor play area contains a total of 1,600 square feet, which will accommodate Applicant's request for 8 school-age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Incidental Medical Services and a Plan of Operation is located in the facility file. 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.

Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: ST. PATRICK'S CATHOLIC PRE-SCHOOL	FACILITY NUMBER: 054500363
	VISIT DATE: 04/05/2021

NARRATIVE

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AS discussed the following: supervision; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Applicant 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.

This facility evaluation report was discussed and emailed to the Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

The following items are required before a license will be issued:
1. Final file review by Licensing Program Manager (LPM) Jeanne Smith

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC809 (FAS) - (06/04)

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