485407523-9-16-2019-13-CC-MMAZ-BG3PSR-20190916113446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 485407523
Report Date: 09/16/2019
Date Signed: 09/16/2019 11:34:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	MARKHAM ELEMENTARY STATE PRESCHOOL CLASSROOM		FACILITY NUMBER:	485407523
ADMINISTRATOR:	SOLER, RAFAEL		FACILITY TYPE:	850
ADDRESS:	101 MARKHAM AVENUE		TELEPHONE:	(707) 453-7217
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95688
CAPACITY:	24	CENSUS: 0	DATE:	09/16/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Lauren Hylton		TIME COMPLETED:	11:45 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	A pre-licensing inspection was conducted by LPAs Martinez and Marks, in response to an application received on 3/11/19, requesting a preschool license for 24 preschoolers ages 3-5. LPAs met with director Lauren Hylton. Operating hours will be Mon-Fri, 8:15AM -11:15AM for the morning and an afternoon class at 12PM-3PM following the school year plan. The fire clearance approval for the requested capacity of 24 was received on 8/28/19. The building was toured, inspected and measured for space. There is one classroom being used for the children in classroom 25 and measured for 24 children. There is two toilets and two sinks in the classroom available for children's use.The nurses office will be used as the isolation area for a sick child. There is a separate staff restroom. The director stated poisons will be stored on site with the janitorial service. There is a working smoke detector/sprinkler system and fire extinguishers in the facility. A carbon monoxide detector is working an the classroom. Items that could pose a danger to children (cleaning compounds, medication, etc) will be inaccessible. At this time, the director stated food will be brought by the elementary school kitchen. There is a refrigerator in the classroom to hold snacks and prepped food. There were no hazards observed in the classrooms. The director stated no firearms or ammunition will be stored on site and none were observed. There will be a shared play yard, used at different times by different age groups and the shared school. The play yard measured sufficient for only 115 children. There are safe toys and age appropriate equipment. There is sufficient shade. The director stated water will be provided inside and outside via drinking fountains. There is rubberized cushioning and bark under the climbing structure to absorb falls. There were no hazards or bodies of water observed in the outside play area. See LIC 809C for further

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah Martinez	TELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MARKHAM ELEMENTARY STATE PRESCHOOL CLASSROOM	FACILITY NUMBER: 485407523
	VISIT DATE: 09/16/2019

NARRATIVE

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Unusual Incident Reporting and posting document requirements were discussed. Children and staff records to be maintained were reviewed. Staff qualifications and ratio requirements were reviewed. 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:www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the director.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department. The following needs to be completed prior to the granting of license. Please include facility number in all correspondence.

1. Managerial review and approval of shared yard waiver request

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Mikah Martinez	TELEPHONE: (530) 895-4014
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019

LIC809 (FAS) - (06/04)

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