343616737-6-2-2021-03-CC-RPIS-C3LR9R-20210602124959

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616737
Report Date: 05/24/2021
Date Signed: 06/02/2021 12:50:12 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:	CALVARY CHRISTIAN SCHOOL-AGE CARE		FACILITY NUMBER:	343616737
ADMINISTRATOR:	ARRIAGA, SUSAN		FACILITY TYPE:	840
ADDRESS:	4911 47TH AVENUE		TELEPHONE:	(916) 393-3633
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95824
CAPACITY:	20	CENSUS: 27	DATE:	05/24/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Susan Arriaga		TIME COMPLETED:	01:30 PM

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	At 10:30 AM, Licensing Program Analyst (LPA) Rosie Pitts met with Director Susan Arriaga for the purpose of an announced case management tele-inspection. Prior to this visit, the Director requested to increase the capacity from 20 to 40 in classrooms 1 and 2. Currently, the program is operating under the "Emergency Child Care Waiver Novel Coronavirus 2019 (COVID-19). Previously, the program operated from classroom 1. The program will operate Monday through Friday from 6:00AM to 6:00PM. LPA received a Fire clearance on May 17, 2021. INDOOR ACTIVITY SPACE: LPA observed the following documents and forms are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat poster, menus, COVID-19 Safety guidance posters, and daily schedule. The facility provides breakfast, lunch and afternoon snack. LPA observed a sufficient amount of equipment, toys, tables, chairs, napping cots, and cubbies for the requested capacity. LPA observed a first aid kit and medication box. Cleaning disinfectants are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Functional carbon monoxide and smoke detectors were observed. Director measured classrooms: 1 and 2; LPA walked her through the measuring process. The 2 classroom spaces contain a total of 1656.618 square feet, which accommodates the request for 40 School Age children. There are eight toilets and ten sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary. Report continues on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: 916-862-1086
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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: CALVARY CHRISTIAN SCHOOL-AGE CARE	FACILITY NUMBER: 343616737
	VISIT DATE: 05/24/2021

NARRATIVE

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There are two outdoor areas on the property: a preschool yard and school age yard. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas and drinking water available outdoors.

LPA used the measurements of the outdoor space for the preschool and school age yard measurements from previous inspection report dated: 5/02/2008. . The outdoor area contains a total of 11548.91 square feet, which accommodates Licensee's request for16 toddlers, 24 preschool, and 40 School Age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Licensee 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.

An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the tele-inspection This facility evaluation report was reviewed and discussed with Licensee. LPA emailed a copy of the 809 to Licensee. Licensee understands she must read the reports and send back an acknowledgement that she read and received the report.

CONDITIONS REQUIRING CORRECTION PRIOR TO APPROVAL OF CAPACITY INCREASE:
1. Licensee will submit an updated LIC 200A with a capacity of 16 toddlers, 24 preschool, and 40 School Age children. The STD. 850 already reflects the requested capacity

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Rosie Pitts	TELEPHONE: 916-862-1086
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC809 (FAS) - (06/04)

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