393617290-1-30-2023-53-CC-ASIS-CNKPKC-20230130102255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393617290
Report Date: 01/30/2023
Date Signed: 01/30/2023 10:23:03 AM

Document Has Been Signed on 01/30/2023 10:23 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	CAPC - FRENCH CAMP		FACILITY NUMBER:	393617290
ADMINISTRATOR:	BALLARD, KIM		FACILITY TYPE:	850
ADDRESS:	241 E. 4TH STREET		TELEPHONE:	(209) 464-4524
CITY:	FRENCH CAMP	STATE: CA	ZIP CODE:	95231
CAPACITY:	24	CENSUS: 0	DATE:	01/30/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kim Ballard		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	Application Specialist (AS) Alecia Sifuentes met with Early Education Director, Kim Ballard for the purpose of a case management inspection. Licensee requests a room change to room J11. Licensee is not making any changes to the licensed capacity. The preschool program is located at French Camp Elementary School. The program operates Monday through Friday from 8:00 a.m. to 3:30 p.m. INDOOR ACTIVITY SPACE: There is one preschool classroom located in room J11. AS observed a sufficient amount of equipment, toys, tables, chairs, and cubbies. AS measured the classroom. The total classroom space contains a total of 885 square feet, which will accommodate Licensee’s current capacity of 24 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). AS observed a Shared Bathroom Waiver on file. OUTDOOR ACTIVITY SPACE: There are two outdoor areas on the property, preschool playground and the elementary school playground. AS observed a Shared Outdoor Space Waiver on file. AS measured the outdoor space. The outdoor area contains a total of 9,865 square feet, which will accommodate Licensee’s current capacity of 24 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Report continues on LIC809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CAPC - FRENCH CAMP	FACILITY NUMBER: 393617290
	VISIT DATE: 01/30/2023

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A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Early Education Director, Kim Ballard.

The following items are required before the room change will be approved:
1. Updated granted fire clearance (STD850)
2. Updated application (LIC200A)

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC809 (FAS) - (06/04)

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