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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343608074
Report Date: 05/03/2021
Date Signed: 05/04/2021 08:45:00 AM

Document Has Been Signed on 05/04/2021 08:45 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:EARLY CHILDHOOD ED. CTR OF SAC. COUNTRY DAY SCHOOLFACILITY NUMBER:
343608074
ADMINISTRATOR:MAPA, MARIAFACILITY TYPE:
850
ADDRESS:2636 LATHAM DR.TELEPHONE:
(916) 481-8811
CITY:SACRAMENTOSTATE: CAZIP CODE:
95864
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 24DATE:
05/03/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jay HolmanTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Christopher Bello met with Director Jay Holman using the FaceTime application for a Tele-inspection. Today’s inspection regarded a capacity increase from 24 children to 41 preschool children ages four to five years old and approval for use of room 124. Fire Clearance was granted on 4/28/2021. LPA inspected the areas where care will be provided and observed that the facility was in compliance with Title 22 regulations and the Health and Safety Code.

INDOOR ACTIVITY SPACE:
Room 123 Activity Space = 976 square feet, divided by 35 square feet, and sufficient indoor activity space to support total of 27 children.
Room 124 Activity Space = 529 square feet, divided by 35 square feet, and sufficient indoor activity space to support total of 15 children.
The facility has sufficient space to support the requested amount.

Effective today 5/3/2021, the facility is licensed for 41 preschool children ages four to five years old in rooms 123 and 124.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report and provided copies of the report, Notice of Site Visit and appeal rights via email. An exit interview was conducted. The director will send an email back stating that they received the documents to act as their virtual signature.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2021
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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