394500266-2-1-2021-53-CC-SDLA-BXTMLB-20210201084202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500266
Report Date: 01/29/2021
Date Signed: 02/01/2021 08:42:10 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:	MONTESSORI ON THE PRAIRIE		FACILITY NUMBER:	394500266
ADMINISTRATOR:	TENNAKOON, SHANIKA		FACILITY TYPE:	840
ADDRESS:	89 WEST 7TH STREET		TELEPHONE:	(209) 831-7872
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	10	CENSUS: 0	DATE:	01/29/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Shanika Tennakoon		TIME COMPLETED:	12:30 PM

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 (LPA) Stacey Williams met with Director Shanika Tennakoon for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Director requests a school-age license to serve nine school-age children enrolled in first grade and above. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. Director 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. The facility will provide afternoon snacks when school is in session. The facility will provide morning snacks when school is out of session, and parents will provide lunches. INDOOR ACTIVITY SPACE: There is one school-age classroom. AS and LPA observed a sufficient amount of equipment, toys, tables, chairs, and cubbies. AS and LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Director stated first aid kit and medications will be stored in the office. Director stated there are no poisons or firearms on the premises. Director stated there will be pitchers and water cups available in each classroom. Director 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: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

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: MONTESSORI ON THE PRAIRIE	FACILITY NUMBER: 394500266
	VISIT DATE: 01/29/2021

NARRATIVE

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Director measured the classroom; and AS walked her through the measuring process. The total classroom space contains a total of 441 square feet, which accommodates Director's request for nine school-age children. There are three toilets and six sinks for the children, and a separate private restroom for the staff. The restroom designated for school-age children affords privacy and gender separation and is next to the staff restroom. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor play area for children. The play space is surrounded by a wooden fence that is at least four feet tall. AS and LPA observed a sufficient amount of equipment and toys. Applicant stated shade will be supplied by a tent. There is a climbing structure that has a safety label that reads it is intended for children ages three to ten years old. Director stated the climbing structure is anchored into the ground. Director acknowledges staff must ensure children use age-appropriate equipment at all times.

Director measured the outdoor space; and AS walked her through the measuring process. The outdoor play area contains a total of 2551 square feet, which accommodates Director's request for nine school-age children. Director will submit a shared outdoor space waiver request to AS. 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: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MONTESSORI ON THE PRAIRIE	FACILITY NUMBER: 394500266
	VISIT DATE: 01/29/2021

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

AS discussed with Director 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 Director. Director 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 Director. AS emailed a copy of the 809 to Director. Director understands she must reply that she received, read, and understands the report. AS provided LIC311A and Effects of Lead Exposure brochure.

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: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

LIC809 (FAS) - (06/04)

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