093623346-2-4-2020-03-CC-JHOA-BLGQGP-20200204110952

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093623346
Report Date: 02/04/2020
Date Signed: 02/04/2020 11:10:05 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:	ALL STAR GYMNASTICS		FACILITY NUMBER:	093623346
ADMINISTRATOR:	VANRY, ANDREA		FACILITY TYPE:	850
ADDRESS:	6160 ENTERPRISE DR SUITE A		TELEPHONE:	(530) 622-7684
CITY:	DIAMOND SPRINGS	STATE: CA	ZIP CODE:	95619
CAPACITY:	12	CENSUS: 10	DATE:	02/04/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Andrea Van Ry		TIME COMPLETED:	11:30 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	Licensing Program Analysts (LPAs), Jan Hoshida, Christopher Jackson and Michelle Pascual, met with Applicant Andrea Van Ry for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 12 preschool children from age three to five years old. The program’s hours of operation are Mondays, Wednesdays and Fridays from 9:00am to 2:30pm and Tuesdays and Thursdays from 9:00am to 12:00pm. The center offers two part day preschool classes. The fire clearance was granted on 12/10/19. Upon arrival, LPAs observed 10 preschool children supervised by two staff members. Applicant requested for a pre-licensing inspection for the potential outdoor area that will be renovated to for the facility’s outdoor activity space. LPAs observed that Applicant has been approved by her property management to use the grass triangle space in front of the building. Applicant stated that she will be installing a fence that is at least four feet tall and will be purchasing age-appropriate outside activity equipment and toys. Applicant stated that the building provides sufficient amount of shade. Applicant understands that per Title 22 licensing regulations, it is required that children must have outdoor activity space of 75 square feet per child which is 900 square feet due to the requested capacity of 12 preschool children. Applicant understands that she must submit a waiver request for the outdoor activity space if the facility would have less that the required amount. Applicant understands that LPAs must come back to re-measure and re-inspect the outdoor activity space after construction has been completed. *REPORT CONTINUED ON NEXT PAGE*

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020

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: ALL STAR GYMNASTICS	FACILITY NUMBER: 093623346
	VISIT DATE: 02/04/2020

NARRATIVE

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LPAs measured the main gym floor, preschool classroom and upstairs play area. The total inside space contains a total of 7,633.153 square feet, which will accommodate Applicant's request for 12 preschool children. There are two toilets and two 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.

The following items are required before a license will be issued:

1. Completion of outdoor activity space.

2. Additional pre-licensing inspection.

3. Additional application paperwork (Director’s qualifications).

4. LPM’s final file review.

This facility evaluation report was reviewed and discussed with 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.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan Hoshida	TELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020

LIC809 (FAS) - (06/04)

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