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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623346
Report Date: 04/09/2020
Date Signed: 04/13/2020 08:27:52 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 GYMNASTICSFACILITY NUMBER:
093623346
ADMINISTRATOR:VANRY, ANDREAFACILITY TYPE:
850
ADDRESS:6160 ENTERPRISE DR SUITE ATELEPHONE:
(530) 622-7684
CITY:DIAMOND SPRINGSSTATE: CAZIP CODE:
95619
CAPACITY:12CENSUS: 0DATE:
04/09/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Andrea Van RyTIME COMPLETED:
10:00 AM
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Application Specialist (AS) Seychelle De Luca met with Applicant Andrea Van Ry for the purpose of an announced prelicensing tele-inspection, due to COVID-19.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. Applicant measured the fence, which is 4 feet and 2 inches tall. There are no bodies of water on the premises. There is shade supplied by the building. There is no water fountain located outside; and Applicant stated that staff can bring a water pitcher and cups outside. Applicant also stated children will bring their own water bottles.

During today's tele-inspection, Applicant and her husband measured the outdoor space. Prior to today's tele-inspection, Applicant emailed photos of the fenced outdoor space. The outdoor play area contains a total of 518.324 square feet, which will not accommodate the request for 12 preschool children. An outdoor sketch and a waiver request to utilize a rotating schedule where no more than six children will use the outdoor space at one time will be submitted today. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility evaluation report was reviewed and discussed with Applicant. AS emailed a copy of the 809 to Applicant. Applicant understands she must open the email to send back an acknowledgement of receipt.

Effective today, AS is issuing a provisional license that will expire on December 31, 2020. LPM Bettina Engelman must conduct a final file review. Applicant acknowledges that Director's packet must be submitted prior to expiration of the provisional license for final approval of license.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2020
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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