313623785-1-4-2021-03-CC-SDLA-BWXSUZ-20210104131157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623785
Report Date: 12/22/2020
Date Signed: 01/04/2021 01:12:22 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:	LILY PAD EARLY LEARNING CENTER		FACILITY NUMBER:	313623785
ADMINISTRATOR:	ZEMLICKA, MICHELLE		FACILITY TYPE:	850
ADDRESS:	3330 CHISOM TRAIL		TELEPHONE:	(530) 863-9443
CITY:	LOOMIS	STATE: CA	ZIP CODE:	95650
CAPACITY:	30	CENSUS: 0	DATE:	12/22/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Michelle Zemlicka		TIME COMPLETED:	10:00 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) Seychelle De Luca and Licensing Program Analyst (LPA) Amanda Blesi met with Applicant Michelle Zemlicka for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Applicant requests a preschool license to serve 30 preschool children from age two to entry into kindergarten. The program will operate Monday through Sunday from 6:30 AM to 5:30 PM. The fire clearance was granted on 12/18/2020. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, Effects of Lead Exposure brochure, menus, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. The facility will provide breakfast, lunch, and snacks. INDOOR ACTIVITY SPACE: There are three preschool classrooms: Classroom A, Classroom B, and Playroom. AS and LPA observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in the kitchen. AS and LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated medications will be stored in the office. Applicant stated there are no poisons or firearms on the premises. Applicant stated there will be water cups available in each classroom. Applicant stated the carbon monoxide detector is hardwired into the system. Applicant stated the facility will use a paper 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: 12/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2020

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: LILY PAD EARLY LEARNING CENTER	FACILITY NUMBER: 313623785
	VISIT DATE: 12/22/2020

NARRATIVE

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Applicant measured the classrooms; and AS walked her through the measuring process. The total classroom space contains a total of 1050.763 square feet, which accommodates Applicant's request for 30 preschool children. There are four toilets and five 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 and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
The outdoor play area has a wrought iron fence that is at least four feet tall. AS and LPA observed a sufficient amount of equipment and toys. There is a pond on the other side of the back fence; and Applicant stated the pond is not on the property. The fence separates the play area from the space with the pond. There are shaded areas supplied by trees. Applicant acknowledges staff must ensure children use age-appropriate equipment at all times.

AS measured the outdoor activity space. The outdoor play area contains a total of 13,193.16 square feet, which accommodates Applicant's request for 30 preschool children. 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 (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: 12/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2020

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 EARLY LEARNING CENTER	FACILITY NUMBER: 313623785
	VISIT DATE: 12/22/2020

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AS discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; criminal record clearances, 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 directors 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 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.

This facility evaluation report was reviewed and discussed with Director. AS emailed a copy of the 809 to Applicant. Applicant understands she must reply that she received, read, and understands the report. AS provided LIC311A, Effects of Lead Exposure brochure, and immunization card.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. A final review of the file by Licensing Program Manager (LPM) Keven Peters.
2. Remaining paperwork must be submitted to AS.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2020

LIC809 (FAS) - (06/04)

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