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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343615667
Report Date: 08/01/2019
Date Signed: 08/01/2019 09:26:04 AM

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:MADISON ELEMENTARY SCHOOLFACILITY NUMBER:
343615667
ADMINISTRATOR:NAOMI JANSSENFACILITY TYPE:
850
ADDRESS:5241 HARRISON STREETTELEPHONE:
(916) 566-1900
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:24CENSUS: 9DATE:
08/01/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lena Sounders and Elizabeth CunnionTIME COMPLETED:
09:30 AM
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Licensing Program Analysts (LPAs) Tanya Washington and Seychelle De Luca met with Teacher on Special Assignment Lena Sounders and Licensing Representative Elizabeth Cunnion for the purpose of an unannounced case management inspection. Licensee requested to increase from a capacity of 24 pre-school age children to 48 pre-school age children. Facility is currently pending approval of the fire clearance for the additional room added (room #2). Facility will run a full day program in both classrooms.

A health and safety inspection was conducted in all areas accessible to children. LPAs measured room #2 which measured for 1,173.66 square feet. LPAs did not measure room #3 or the outdoor area during today's inspection. LPAs used the measurement from pre-licensing inspection which was conducted 02/27/2009. The total indoor capacity square footage is 2, 119.66. This will accommodate Licensee's request for 48 pre-school age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). There are two toilets and two sinks in room #2 and 1 sink in room #3. Facility has a waiver in place for additional toilets located on the grounds of Madison Elementary School. Facility also has a waiver in place for shared play yard use with the elementary school.

Licensing Representative was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.
An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection. A Notice of Site Visit was provided and should remain posted for 30 days for parental review.

Upon receipt of fire clearance, LPA will issue an updated license to reflect the capacity increase request.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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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