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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620673
Report Date: 08/11/2020
Date Signed: 08/11/2020 04:03:03 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:FIRST STREET SCHOOL PSFACILITY NUMBER:
313620673
ADMINISTRATOR:YEATES,VENUSE/JANINE BENETFACILITY TYPE:
850
ADDRESS:1400 1ST STREETTELEPHONE:
(530) 745-1380
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:24CENSUS: 0DATE:
08/11/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Teresa Dawson-RobertsTIME COMPLETED:
10:00 AM
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On August 11, 2020 at 9:30 AM, Licensing Program Analyst Amanda Blesi contacted Teresa Dawson Roberts for a scheduled Case Management tele-inspection for a room change. The facility is moving from room #6 to the free standing portable located near the school parking lot. The visit is being conducted via FaceTime due to COVID19 pandemic.

The facility is located on the First Street Elementary School campus. An approved fire clearance was received on 7/24/2020 for 24 preschool children to use the portable. An updated facility sketch was submitted and attached to facility profile electronic database.
INDOOR ACTIVITY SPACE:
LPA virtually observed a fully furnished classroom including tables, chairs and a first aid kit. There was a working Carbon Monoxide Detector present. There is one toilet and one sink in the classroom and facility will use the existing waiver on file to share the elementary school bathroom. Individual water bottles will be used by the children for drinking water. The room has hand sanitizer available throughout for children to use. Measurement of the classroom was completed by staff during the virtual inspection. Indoor space measured 842 square feet which will accommodate the requested capacity of 24 preschool children.
OUTDOOR ACTIVITY SPACE:
Refer to the original pre-licensing report for outdoor activity space. There are no changes.
Effective today room change to the portable approved for use by 24 preschool children. In lieu of Director's signature, LPA is e-mailing the report and director shall respond that she received a copy of the report. Notice of Site Visit was provided and should be posted in a conspicuous area for 30 days. No Title 22 deficiencies are cited during the tele-visit.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2020
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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