313623849-1-28-2021-03-CC-SDLA-BXPT8F-20210128133016

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623849
Report Date: 01/28/2021
Date Signed: 01/28/2021 01:30:22 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:	LA PETITE ACADEMY - EUREKA		FACILITY NUMBER:	313623849
ADMINISTRATOR:	COURTNEY WILLIAMS		FACILITY TYPE:	840
ADDRESS:	1800 EUREKA RD		TELEPHONE:	(916) 783-7700
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	14	CENSUS: 0	DATE:	01/28/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Teresea Addison		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	Application Specialist (AS) Seychelle De Luca and Licensing Program Analysts (LPAs) Jeremey McClain and Alize Tillery met with Applicant Teresa Addison for the purpose of an announced prelicensing change of ownership tele-inspection (due to COVID-19). This is a change of ownership from Prestige Preschool Academy (#313619779). Applicant requests a school-age license to serve 14 school-age children enrolled in kindergarten and above. The program will operate Monday through Friday from 6:30 AM to 6:30 PM. The fire clearance was granted on 1/20/2021. 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 afternoon snack. INDOOR ACTIVITY SPACE: There is one school-age classroom. AS and LPAs observed a sufficient amount of equipment, toys, tables, chairs, and hooks. Applicant stated cubbies have been ordered for the school-age room. There is a first aid kit in the classroom and the office. AS and LPAs 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 pitchers and water cups available in the classroom. AS and LPAs observed a carbon monoxide detector in the hallway. Applicant stated the facility will use 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: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

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: LA PETITE ACADEMY - EUREKA	FACILITY NUMBER: 313623849
	VISIT DATE: 01/28/2021

NARRATIVE

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Applicant measured the classroom; and AS walked her through the measuring process. The total classroom space contains a total of 492.1875 square feet, which accommodates Applicant's request for 14 school-age children. There are nine toilets, one urinal, and 12 sinks for the children, and a separate private restroom for the staff. The school-age restroom has one toilet, one urinal, and one sink. Applicant stated they will utilize an "In Use" sign to ensure only one child uses the restroom at a time. 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:
There is one play area for school-age children. The outdoor play area is surrounded by a wrought iron fence that is at least four feet tall. The school-age yard is separated from the preschool and infant yards by a fence. AS and LPAs observed a sufficient amount of equipment and toys. There are shaded areas supplied by trees and overhangs. Applicant acknowledges staff must ensure children use age-appropriate equipment at all times.

Applicant measured the outdoor space; and AS walked her through the measuring process. The outdoor play area contains a total of 5921.295 square feet, which accommodates Applicant's request for 14 school-age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the Administrative 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: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

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: LA PETITE ACADEMY - EUREKA	FACILITY NUMBER: 313623849
	VISIT DATE: 01/28/2021

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AS discussed the following: 100% supervision is required at all times; 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 Applicant. 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 and Effects of Lead Exposure brochure.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. A final review of the file by Licensing Program Manager (LPM) Keven Peters.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

LIC809 (FAS) - (06/04)

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