394500417-6-15-2021-53-CC-ASIS-C3ZUQS-20210615154736

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500417
Report Date: 06/15/2021
Date Signed: 06/15/2021 03:47:57 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:	ACHIEVERS		FACILITY NUMBER:	394500417
ADMINISTRATOR:	KOHLI, DIVYA		FACILITY TYPE:	840
ADDRESS:	4453 PRECISSI LANE		TELEPHONE:	(209) 956-5437
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	14	CENSUS: 10	DATE:	06/15/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Divya Kohli		TIME COMPLETED:	04:00 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) Alecia Sifuentes met with Applicant, Divya Kohli for the purpose of an announced pre-licensing change of ownership inspection. Applicant requests a school-age license to serve 14 school-age children from kindergarten and above. The program will operate Monday through Friday from 6:30 a.m. to 6:00 p.m. The fire clearance was received and granted on 6/15/2021. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat poster, menus, and daily schedule. The facility will be providing afternoon snack during the school year and breakfast, lunch, and snacks during holidays and summer. INDOOR ACTIVITY SPACE: There is 1 school-age classroom and 1 multipurpose room that is divided by a four foot tall removable wall partition to separate the space from the preschool children.. AS observed a sufficient amount of equipment, tables, chairs, and cubbies. There is a first aid kit in the lounge. Medications will be stored in the kitchen. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. AS observed a water pitcher and cups in the classroom. AS observed a functional carbon monoxide detector in the kitchen. AS observed sign-in/sign-out binders. Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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: ACHIEVERS	FACILITY NUMBER: 394500417
	VISIT DATE: 06/15/2021

NARRATIVE

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AS measured two classrooms. The total classroom space contains a total of 694.83 square feet, which will accommodate Applicant's request for 14 school-age children. There are 2 toilets and 2 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 the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one school-age outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall. The school-age yard is separated from the preschool yard by by an empty grass slot. The school-age yard has a separate play structure from the preschool children. 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.

AS measured the outdoor activity space. The outdoor play area contains a total of 1,265.23 square feet, which will accommodate Applicant's request for 14 school-age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

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: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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: ACHIEVERS	FACILITY NUMBER: 394500417
	VISIT DATE: 06/15/2021

NARRATIVE

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AS discussed the following: supervision; 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 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 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.

AS will issue a provisional license that will expire in 90 days on 9/13/2021. Once the provisional is issued, the following items are remaining prior to expiration of the provisional license for final approval of license:

1. Final file review from Licensing Program Manager (LPM) Bettina Engelman.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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