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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623951
Report Date: 06/18/2021
Date Signed: 06/18/2021 11:57:52 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:TOTS OF LOVE - CITRUS HEIGHTSFACILITY NUMBER:
343623951
ADMINISTRATOR:COURTNEY WILLIAMSFACILITY TYPE:
840
ADDRESS:7312 ANTELOPE RDTELEPHONE:
(916) 560-9699
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:10CENSUS: 0DATE:
06/18/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Courtney WIlliamsTIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Christopher Bello and Licensing Program Manager (LPM) Keven Peters conducted a site inspection for the purpose of a prelicensing evaluation. LPA met with applicant Courtney Williams. The facility is requesting an School aged license with a capacity of 10 children. LPA observed that the facility had the required documents posted on the parent board in the main entrance of the facility: Parents Rights, Personal Rights, Car Seat Law, Emergency Disaster Plan, Earthquake Checklist, Electronic sign in/out waiver and facility Menu. The facility will operate Monday-Friday from 6:30am-6:00pm. LPA reviewed all required records with the applicant that the facility must maintain for all the children, staff and volunteers. LPA advised applicants that anyone working in the facility must obtain a criminal record clearance through Community Care Licensing.

LPA discussed Departments inspection authority regulations with the applicants and informed them that if any changes occur regarding the Designee/Director or an employee acting in their absence must be reported to Department within 10 working days. LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPAs advised applicants that if any unusual incidents occur they must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the

INDOOR ACTIVITY SPACE:
Dragonflies Room and Fireflies Room = 376.76 square feet
The total square feet will support the requested 10 children.

Snacks will be prepared in the kitchen, food preparation area, equipment, dishes are sanitary and in good repair. The facility will provide AM/PM snack.

Report continued in on 809 C.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: TOTS OF LOVE - CITRUS HEIGHTS
FACILITY NUMBER: 343623951
VISIT DATE: 06/18/2021
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The applicant will use the office to isolate sick children and the children will be accompanied by a qualified staff. LPA advised applicants on medication requirements and they are aware that all medications must be centrally stored. The facility has a locked box and fridge in the Director's office for medications. 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.

OUTDOOR ACTIVITY SPACE:
The outdoor activity space was measured to be 6232.965 square feet.

The following to be submitted prior to approval;
1) Shared Playground waiver
2) Applicant will provide pictures with the wall fixtures setup.
3) Fire Clearance

Once the above items have been completed, LPA and LPM Keven Peters will review the application. Upon LPM's approval LPA will recommend a provisional license for 10 school age children ages six to 17 years old.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
LIC809 (FAS) - (06/04)
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