343623181-10-7-2019-03-CC-SDLA-BGQLS3-20191007090000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623181
Report Date: 10/07/2019
Date Signed: 10/07/2019 09:00:11 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:	SETA AMERICAN LEGION HEAD START		FACILITY NUMBER:	343623181
ADMINISTRATOR:	KENNEDY, JOANNE		FACILITY TYPE:	850
ADDRESS:	3801 BROADWAY BLVD.		TELEPHONE:	(916) 263-3800
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95817
CAPACITY:	16	CENSUS: 0	DATE:	10/07/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Jose Diaz and Betsy Uda		TIME COMPLETED:	09:15 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	Application Specialist (AP) Seychelle De Luca and Licensing Program Analyst (LPA) Marea Behvand met with Facility Coordinator Jose Diaz and Head Start Program Officer Betsy Uda for the purpose of an announced prelicensing change of ownership inspection. The facility has an emergency approval to operate. Applicants request a preschool license to serve 16 toddler children from 18 to 36 months of age under a Toddler Option. At this time, Applicants will not serve any preschool children, and they acknowledge that they must contact Community Care Licensing prior to enrolling preschool children. The program will operate Monday through Friday from 8:00 AM to 5:00 PM. Applicants acknowledge that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, menus, and daily schedule. AP and LPA discussed the forms that must be in each child's and each staff member's file and AP and LPA provided LIC311A. Food will be prepared and delivered by SETA's central kitchen. The facility will be providing breakfast, lunch, and snacks. INDOOR ACTIVITY SPACE: There are two toddler classrooms (Classrooms 1 and 2). AP and LPA observed a sufficient amount of tables, chairs, cubbies, and napping cots. There is a first aid kit in each of the classrooms. Medications will be stored in each of the classrooms in a locked box. AP and LPA observed cleaning disinfectants appropriately stored and inaccessible to children. Applicants stated there are no poisons on the premises. AP and LPA observed water will be accessible both indoor and outdoor. AP and LPA observed a functional carbon monoxide detector in each classroom. AP and LPA observed an electronic sign-in/sign-out system. Report continues on 809-C

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019

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: SETA AMERICAN LEGION HEAD START	FACILITY NUMBER: 343623181
	VISIT DATE: 10/07/2019

NARRATIVE

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The classroom space was measured. The total classroom space contains a total of 1304.55 square feet, which will accommodate Applicants' request for 16 toddlers. There are two toilets and two sinks for the children and a separate private restroom for the staff. Changing tables have a padded surface that is washable. 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.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall. There are no firearms or bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

The outdoor activity space was measured. The outdoor play area contains a total of 2041.94 square feet, which will accommodate Applicants' request for 16 toddlers. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the facility file. Incidental Medical Services and a Plan of Operation is located in the facility file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Report continues on 809-C

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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: SETA AMERICAN LEGION HEAD START	FACILITY NUMBER: 343623181
	VISIT DATE: 10/07/2019

NARRATIVE

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AP and LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AP and LPA discussed with Applicants any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.

This facility evaluation report was reviewed and discussed with the Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:

1. Fire Clearance

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: 916-217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

LIC809 (FAS) - (06/04)

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