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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318380
Report Date: 08/09/2021
Date Signed: 08/09/2021 04:23:03 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:PETER J. SHIELDS ELEMENTARY SCHOOLFACILITY NUMBER:
340318380
ADMINISTRATOR:MORRIS, VERONICAFACILITY TYPE:
850
ADDRESS:10434 GEORGETOWN DRIVETELEPHONE:
(916) 635-5416
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:24CENSUS: 0DATE:
08/09/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jacqueline WyseTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Jan Hoshida met with Administrator Jacqueline Wyse for the purpose of a case management inspection to inspect the new portable building. On 04/05/21, facility submitted an application to inform CCL that they will be moving a pre-existing portable building to replace the old portable, to be placed in the same location. Administrator requested for the same capacity to serve 24 preschool children 3 to 5 years old. The program will operate Monday through Friday from 8:00 AM to 11:00 AM. There were no day care children present during the inspection since the school year has not started.

LPA conducted a health and safety inspection inside and outside of the facility.

INDOOR ACTIVITY SPACE:
There is one preschool classroom. LPA observed a sufficient amount of equipment, toys, tables, chairs, and cubbies. There is a first aid kit in the classroom. Medications will be stored in the cabinet next to the refrigerator and inaccessible to children. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Administrator stated there are no firearms on the premises. Administrator acknowledged that storage area for poisons needs to be locked and stated that there are no poisons on site. LPA observed a water fountain in the classroom. LPA observed a functional carbon monoxide detector.

LPA measured the classroom. The total classroom space contains a total of 1,431 square feet which will accommodate and maintain current license for 24 preschool children. There are three sinks for the children and separate private restrooms for the staff in the school staff lounge. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

REPORT CONTINUED ON NEXT PAGE
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021
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: PETER J. SHIELDS ELEMENTARY SCHOOL
FACILITY NUMBER: 340318380
VISIT DATE: 08/09/2021
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OUTDOOR ACTIVITY SPACE:
There is one outdoor activity area on the property. The outdoor play area is fenced with a chain-linked fence that is at least four feet tall. There are no bodies of water on the premises. There are shaded areas supplied by trees.

LPA re-measured the outdoor activity space due to the change of fencing location and building placement. The outdoor activity play area contains a total of 7,062.50 square feet which will accommodate and maintain current license for 24 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility evaluation report was reviewed and discussed with Administrator. Administrator 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. LPA discussed current COVID guidelines with Director.

The following items are required before approval of the new portable:
  1. Updated and approved fire clearance.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Administrator and provided copies. An exit interview was conducted. LPA observed the Notice of Site Visit posted and the Administrator understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021
LIC809 (FAS) - (06/04)
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