343623603-11-6-2020-03-CC-SDLA-BV4PWT-20201106104115

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623603
Report Date: 11/06/2020
Date Signed: 11/06/2020 10:41:55 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:	SMALLVILLE PRESCHOOL		FACILITY NUMBER:	343623603
ADMINISTRATOR:	SHANNON NULL		FACILITY TYPE:	830
ADDRESS:	4706 ARDEN WAY		TELEPHONE:	(916) 480-0632
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	30	CENSUS: 0	DATE:	11/06/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Shannon Null		TIME COMPLETED:	11:00 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 (AS) Seychelle De Luca and Licensing Program Analyst (LPA) Karyn Guerra met with Applicant Shannon Null for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Applicant requests an infant license to serve 30 infants from 0-24 months. The program will operate Monday through Friday from 7:00 AM to 5:30 PM. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, Effects of Lead Exposure brochure, menus, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. Parents will provide all food for infants who are not on solid foods. INDOOR ACTIVITY SPACE: There is one infant classroom. AS and LPA observed a sufficient amount of tables, cubbies, toys, and equipment for the requested capacity. The napping area is located in the infant classroom and is separated from the activity area by a half wall that is 4.25 feet tall. There is a first aid kit in the classroom and a trash can with a lid. Applicant stated medications will be stored in the kitchen and IMS medications will be kept in a locked box in inaccessible areas of the classroom. Applicant stated there are no poisons or firearms on the premises. Applicant stated children will bring sippy cups that will be available in the classrooms. Applicant stated the carbon monoxide detector is hardwired into the fire alarm system. Applicant stated the facility will use a paper 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: 11/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020

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: SMALLVILLE PRESCHOOL	FACILITY NUMBER: 343623603
	VISIT DATE: 11/06/2020

NARRATIVE

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Applicant measured the classroom; and AS walked her through the measuring process. The total classroom space contains a total of 1106 square feet, which accommodates Applicant's request for 30 infant children. AS and LPA observed a changing pad that is within arm's reach of a sink. The changing pad is at least one inch thick with raised sides that are at least three inches tall. There are seven toilets, one changing table, and eight 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 a specified area in the classroom and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property that will be shared by infant and preschool children. The outdoor play area has a chain link fence that is at least four feet tall. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs. Applicant acknowledges staff must ensure children use age-appropriate equipment at all times.

Applicant measured the outdoor space; and AS walked her through the measuring process. The outdoor play area contains a total of 9292 square feet, which accommodates Applicant's request for 30 infant children. Prior to today, Applicant requested a shared outdoor space waiver. Applicant acknowledges the waiver must be posted. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the preschool 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: 11/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020

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: SMALLVILLE PRESCHOOL	FACILITY NUMBER: 343623603
	VISIT DATE: 11/06/2020

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AS discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds.

AS discussed with Applicant any changes that may occur regarding the directors or an employee acting in the director's absence must be reported to department within 10 working days.

This facility evaluation report was reviewed and discussed with 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.

This facility evaluation report was reviewed and discussed with Applicant. AS emailed a copy of the 809 to Applicant. Applicant understands she must open the email to send back an acknowledgement of receipt. AS provided LIC311A, Effects of Lead Exposure brochure, safe sleep brochures, immunization card, PIN 20-24, and Infant Sleeping Plan (LIC 9227).

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. Submit updated Application (LIC 200A) for 24 infants.
2. Fire clearance.
3. Waiver request to use Pack 'n Play.
4. Verification of 15 chairs.
5. Verification of sufficient napping mats for requested capacity of 24.
6. Verification napping mat is secured to the foldable changing table.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020

LIC809 (FAS) - (06/04)

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