343623051-9-5-2019-03-CC-KFEA-BFQNDB-20190905102204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623051
Report Date: 09/05/2019
Date Signed: 09/05/2019 10:22:10 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:	KIDS PARK-FOLSOM(PS)		FACILITY NUMBER:	343623051
ADMINISTRATOR:	KAVAN, LADAN SHOJAEI		FACILITY TYPE:	850
ADDRESS:	1111 RILEY STREET		TELEPHONE:	(916) 263-8786
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	60	CENSUS: 0	DATE:	09/05/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ladan Kavan		TIME COMPLETED:	10:30 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) Kelly Ferrara and Licensing Program Manager (LPM) Bettina Engelman conducted a Pre-licensing inspection and met with applicant Ladan Shojaei Kavan and Site Director, Azadeh Amiri. Applicant is requesting a preschool and school age license. The applicant is requesting a license to serve 60 preschool and 60 school-age children with a floating capacity on a drop-in basis. Applicant acknowledged the statutory definition of a drop-in center that precludes any prearranged schedule of care or attendance for any child. Applicant submitted a number of waivers for program flexibility including provision for extra indoor activity space in lieu of outdoor space. The facility will operate seven days a week. The hours of operation are: Monday through Thursday 8 AM-10 PM, Friday 8 AM- Midnight, Saturday 10 AM- Midnight, and Sunday 1 PM- 6 PM. Applicant has a designated Director and a fully qualified teacher to cover these extended hours. The facility has a copy of the following documents posted in a conspicuous area: Parent's Rights, Personal Rights, and Car Seat Law. LPA discussed with the applicant that the Emergency Disaster Plan and Menu must be posted. INDOOR ACTIVITY SPACE: There is one large open room with a sectioned off space for school age children. The facility is equipped with child size furnishings and toys for various ages. There are individual cubbies for storing children's personal belongings and properly stored napping equipment. There is a kitchen area to support the food service equipped with a refrigerator and this area is accessible to children. There is a storage closet which locks that is close to the kitchen area where cleaning compounds are stored. LPA and LPM observed a complete first aid backpack with appropriate supplies. There are drinking fountains for children to use. Children who become ill during the day will be isolated in the office and will use the staff restroom if necessary. Snacks will be provided by the facility and the parents will either bring meals or pay for a meal to be supplied by local restaurants. Each activity space was measured and contains a total of 3,620.67 square feet which will accommodate a maximum of 60 children, based on the waiver request of 60 indoor square feet per child. There are four toilets and four sinks available for use. Two sinks and two toilets are located in separate restrooms, ensuring privacy and gender separation for school-age children.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

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: KIDS PARK-FOLSOM(PS)	FACILITY NUMBER: 343623051
	VISIT DATE: 09/05/2019

NARRATIVE

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Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:

The facility does not have outdoor activity space. A waiver has been requested to not have an outdoor play area. The applicant is requesting a waiver for 60 indoor square feet in lieu of outdoor space. There is a gross motor play area inside the facility. Children will attend the facility up to 20 hours per week, with no one day exceeding 10 hours based on the availability of 60 square feet of indoor space per child.

CONDITIONS REQUIRING CORRECTION PRIOR TO LICENSURE:

1. Applicant and Director must obtain fingerprint clearances to be associated to the facility.
2. Waivers must be reviewed and approved by management.
3. Final file review by management.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

LIC809 (FAS) - (06/04)

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