343623824-2-10-2021-03-CC-SDLA-BY4VBV-20210210151810

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623824
Report Date: 02/10/2021
Date Signed: 02/10/2021 03:18:16 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:	FOREVER FRIENDS EARLY LEARNING CENTER		FACILITY NUMBER:	343623824
ADMINISTRATOR:	BARLATT, KRYSTAL		FACILITY TYPE:	840
ADDRESS:	1355 FLORIN ROAD SUITE 20		TELEPHONE:	(916) 912-0758
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95822
CAPACITY:	25	CENSUS: 0	DATE:	02/10/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Krystal Barlatt		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 Analysts (LPAs) Mai Lor and Alize Tillery met with Licensee Krystal Barlatt for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Licensee requests a school-age license to serve 25 children enrolled in kindergarten and above. The program will operate Monday through Friday from 6:00 AM to 6:30 PM. The fire clearance was granted on 1/26/2021. Licensee acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. AS and LPAs discussed the forms that must be in each child's and each staff member's file. The facility will be providing breakfast, lunch, and snacks. INDOOR ACTIVITY SPACE: There are six activity spaces: Learning Room A, Learning Room B, Learning Room C, Living Room, Study Area, and Front Area. AS and LPAs observed a sufficient amount of equipment, toys, tables, lockers, and chairs. The furniture and equipment are currently in Suite 11 where the school-age option is currently operating. Licensee stated she will move furniture and equipment to Suite 20 once she has approval to use this space. The first aid kit, medication box, and cleaning disinfectants are inaccessible to children. Licensee stated there are no poisons or firearms on the premises. Licensee stated a water jug and cups will be available in all classrooms. AS and LPAs observed functional carbon monoxide detector. Licensee stated she 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: 02/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021

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: FOREVER FRIENDS EARLY LEARNING CENTER	FACILITY NUMBER: 343623824
	VISIT DATE: 02/10/2021

NARRATIVE

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Licensee measured the classroom space, and AS walked Licensee through the measuring process. The total classroom space contains a total of 550 square feet, which does not accommodate Licensee's request for 25 children. The space allows for a maximum of 15 children. There is one toilet toilet and one sinks for the children in Suite 20. The restroom affords privacy and gender separation. There is 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.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. This outdoor space is separated from the infant yard, but shared with the preschool children. The outdoor play area is fenced with a wrought iron and wooden fence that is at least four feet tall. AS and LPAs observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. Licensee stated there is shade supplied by canopies, but they were taken down because of the storms. Licensee stated there are no poisons or firearms on the premises. Licensee stated a water jug and cups will be available outside.

Licensee measured the outdoor space, and AS walked Licensee through the measuring process. The outdoor play area contains a total of 3068.9136 square feet, which accommodates Licensee's updated request for 15 children. 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 (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: 02/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021

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: FOREVER FRIENDS EARLY LEARNING CENTER	FACILITY NUMBER: 343623824
	VISIT DATE: 02/10/2021

NARRATIVE

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AS 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. AS discussed with Licensee any changes that may occur regarding the director 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 Licensee. Licensee 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 Licensee. AS emailed a copy of the 809 to Licensee. Licensee understands she must open the email to send back an acknowledgement of receipt. AS provided LIC311A, Effects of Lead Exposure brochure, and immunization card.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. Final approval by Licensing Program Manager (LPM) Roxana Saravia.
2. Submit updated Application (LIC 200A) with an updated capacity of 15 school-age children.
3. Updated fire clearance for 15 school-age children.
4. Updated sketch with activity spaces clearly labelled and patio included.
5. Waiver request to share the outdoor space with preschool children on a rotating schedule. A schedule of outdoor use by each group will be included.
6. Proof shade structures are put back up in the outdoor space.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021

LIC809 (FAS) - (06/04)

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