313623319-11-26-2019-03-CC-SDLA-BJARBP-20191126115305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623319
Report Date: 11/26/2019
Date Signed: 11/26/2019 11:53:46 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:	LILY PAD LEARNING CTR (INF)		FACILITY NUMBER:	313623319
ADMINISTRATOR:	ZEMLICKA, MICHELLE		FACILITY TYPE:	830
ADDRESS:	1388 LINCOLN WAY		TELEPHONE:	(530) 863-9443
CITY:	AUBURN	STATE: CA	ZIP CODE:	95603
CAPACITY:	7	CENSUS: 5	DATE:	11/26/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Michelle Zemlicka		TIME COMPLETED:	12:00 PM

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) Seychelle De Luca and Licensing Program Analyst (LPA) Marea Behvand met with Applicant Michelle Zemlicka for the purpose of an announced prelicensing change of ownership inspection. Applicant requests an infant license to serve 7 infant children from 0-24 months of age. The program will operate Monday through Friday from 7:00 AM to 5:00 PM. The fire clearance was granted on 11/12/19. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. AS and LPA discussed the forms that must be in each child's and each staff member's file and AS provided LIC311A, Safe Sleep in Child Care, Effects of Lead Exposure brochure, Healthy Schools Act survey, and new immunization card. AS and LPA observed the Needs and Services plans are kept in the classroom. The facility will provide dry snacks. Parents will provide formula, breast milk, and baby food for their children. INDOOR ACTIVITY SPACE: There is one infant classroom: Room 8. AS and LPA observed a sufficient amount of equipment, toys, tables, chairs, high chairs, cubbies, napping mats, and three cribs. AS and LPA observed a first aid kit. Medications will be stored in the upstairs office. AS and LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicants stated there are no poisons or firearms on the premises. AS and LPA observed a changing table within arm's reach of a sink. AS and LPA observed sippy cups for water in the classroom. AS and LPA observed a functional carbon monoxide detector in each classroom and in the office. AS and LPA observed an electronic sign-in/sign-out system. Report continues on 809-C

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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: LILY PAD LEARNING CTR (INF)	FACILITY NUMBER: 313623319
	VISIT DATE: 11/26/2019

NARRATIVE

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AS and LPA measured one classroom. The total classroom space contains a total of 263.2654 square feet, which will accommodate Applicant's request for 7 infant children. There are three toilets and four 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 parlor and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one infant outdoor area, courtyard, on the property. The outdoor play area is fenced that is at least four feet tall. AS and LPA 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 overhangs.

AS and LPA measured the outdoor activity space. The outdoor play area contains a total of 2155.125 square feet, which accommodates Applicant's request for 7 infant. Applicant provided a waiver request for infants and preschool children to share the courtyard. Applicant acknowledges infants and preschool children may not use the space at the same time and has provided schedules to AS. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the facility file. Incidental Medical Services and a Plan of Operation is located in the facility file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

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: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

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: LILY PAD LEARNING CTR (INF)	FACILITY NUMBER: 313623319
	VISIT DATE: 11/26/2019

NARRATIVE

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AS and LPA discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS and LPA discussed with Applicants 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 reviewed and discussed with Applicants. Applicants were 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 prior to final approval of license:

1. LPM Keven Peters’ final file review.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019

LIC809 (FAS) - (06/04)

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