343616796-9-13-2019-03-CC-KGUA-BFYNYR-20190913105310

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343616796
Report Date: 09/13/2019
Date Signed: 09/13/2019 10:53:35 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:	OUR LADY OF THE ASSUMPTION		FACILITY NUMBER:	343616796
ADMINISTRATOR:	GUTIERREZ, YESENIA		FACILITY TYPE:	850
ADDRESS:	5055 COTTAGE WAY		TELEPHONE:	(916) 485-1504
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	30	CENSUS: 0	DATE:	09/13/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:			TIME COMPLETED:	09:20 AM

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	Licensing Program Analyst (LPA) Karyn Guerra met with Director, Yesenia Gutierrez, to conduct a case management visit for a room change. LPA toured the facility, no children were in care. Previously existing Preschool room (convent) was removed, and is under construction. Transitional Kindergarten (TK) program will be provided in former Cottage Room, and Preschool (PS) program will be provided in next door modular. Applicant requests a preschool license for 30 children. The Preschool program in the modular will operate 8:00AM-11:45AM. The TK program will operate from 8:00AM-12:00PM. There are lunch and nap programs that operate following the end of school schedule from 12:00PM-3:00PM. Programs traditionally operate from August to May. The facility has a copy of the following documents posted in a conspicuous area: facility license, parent's rights, personal rights, menus, daily schedule, emergency disaster plan, and car seat law. INDOOR ACTIVITY SPACE: The rooms are equipped with child size furnishings. There are areas designated for the office and kitchen. Children will get water from the water jug and water bottles located in the classroom. TK room measures 868.41 square feet and PS room measures 444.01 square feet for a combined total measurement 1312.42 square feet, which will accommodate the requested capacity of 30 children. There is a separate staff restroom located inside the TK building. Children who become ill during the day will be isolated in a designated area in the classroom and will use the staff restroom, if necessary. Report continues on 809-C.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

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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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: OUR LADY OF THE ASSUMPTION	FACILITY NUMBER: 343616796
	VISIT DATE: 09/13/2019

NARRATIVE

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OUTDOOR SPACE:
Outdoor play space is furnished with child sized furnishings and equipment. Equipment is free of loose or sharp parts. There is a blacktop area and grass area, with adequate shade provided by trees. Drinking water is provided to children via water bottles. Outdoor play space measures 4023.53 square feet, which will accommodate the requested capacity of 30 children.

Effective today, Friday, September 13th, 2019, room change is approved and licensed to serve 30 preschool aged children.

An exit interview was conducted. Notice of Site visit was provided and posted.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019

LIC809 (FAS) - (06/04)

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