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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604338
Report Date: 04/13/2022
Date Signed: 04/13/2022 10:13:03 AM


Document Has Been Signed on 04/13/2022 10:13 AM - It Cannot Be Edited

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:PEACE PRESCHOOLFACILITY NUMBER:
343604338
ADMINISTRATOR:FORTES, KIMBERLYFACILITY TYPE:
850
ADDRESS:9145 FRANKLIN BLVD.TELEPHONE:
(916) 684-2836
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:33CENSUS: 25DATE:
04/13/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kimberly FortesTIME COMPLETED:
11:00 AM
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Application Specialist (AS) Alecia Sifuentes met with Director, Kimberly Fortes for the purpose of an announced change of capacity and room addition case management inspection. Licensee requests to serve 45 preschool children from four years to entry into kindergarten. The program operates Monday through Thursday from 7:00 a.m. to 3:00 p.m, Friday from 7:00 a.m. to 12:00 p.m, and closed for the summer. The fire clearance was granted and received on 3/25/2022.

INDOOR ACTIVITY SPACE:
There are four preschool classrooms (Rooms A, B, C, and D). AS observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. AS used current classroom measurements for Rooms A, B, C and measured Room D. The total classroom space contains a total of 1,605 square feet, which will accommodate Licensee's request for 45 preschool children. There are 4 toilets and 4 sinks for the children, and a separate private restroom for the staff.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. AS used current outdoor measurements. The outdoor play area contains a total of 3,562 square feet, which will accommodate Licensee's request for 45 preschool children.

Licensee was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Report continues on LIC809-C.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2022
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: PEACE PRESCHOOL
FACILITY NUMBER: 343604338
VISIT DATE: 04/13/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Director, Kimberly Fortes. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Effective today, 4/13/2022, AS will approve the capacity change of 45 licensed to serve children from age 2 years to entry into kindergarten.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC809 (FAS) - (06/04)
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