485408010-12-23-2021-13-CC-LCHZ-C9YVRG-20211223153956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 485408010
Report Date: 12/22/2021
Date Signed: 12/23/2021 03:40:07 PM

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:	WORLD CHANGERS ACADEMY		FACILITY NUMBER:	485408010
ADMINISTRATOR:	MEJIA, ERICA		FACILITY TYPE:	840
ADDRESS:	470 EAST H STREET		TELEPHONE:	(707) 365-5639
CITY:	DIXON	STATE: CA	ZIP CODE:	95620
CAPACITY:	60	CENSUS: 0	DATE:	12/22/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Erica Mejia		TIME COMPLETED:	04:45 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	On 12/22/2021 at 2:30pm, Licensing Program Analyst (LPA) Laura Chavez conducted a prelicensing inspection to the facility in response to an application received requesting to add a school-age license. The requested capacity is 60. A fire inspection approval was received on 12/14/2021. The facility is located at the Freedom Church. Signs providing COVID-19 information are posted throughout the facility. The facility currently holds a preschool license. The school-age program will operate in the sanctuary. Days and hours of operation will be Monday-Friday; 6:30am-6:00pm. The applicant understands that preschool and school age children are not to be commingled inside or outside. A review of the Facility Personnel Report Summary dated 12/21/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. At least one staff person has current CPR and First Aid training. There are working smoke alarms, carbon monoxide detectors and approved fire extinguishers in the facility. All exits are marked. The facility was toured inside and outside and measured for space. There are two separate bathrooms that provide individual privacy for school-age children. There are four sinks and 4 toilets available. There is a separate staff bathroom. The applicant understands that children shall be escorted to the bathroom while maintaining teacher:child ratios. The Directors office is the designated sick room to isolate a sick child. Poisons are locked in the janitorial closet and cleaning supplies are inaccessible to children. At this time the school district will provide breakfast and lunch for children in care. Water jugs and disposable cups are available inside and outside. There are age appropriate toys and activities for children. Report continued: See LIC 809-C

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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

FACILITY NAME: WORLD CHANGERS ACADEMY	FACILITY NUMBER: 485408010
	VISIT DATE: 12/22/2021

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There is a waiver in place for school-age and preschool children to share the outdoor play area at different times. The applicant understands that no more than 45 children will utilize the outdoor play area at one time. There are no bodies of water observed and none will be added without prior approval from the Department.

The following information regarding the American Disabilities Act (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 are available at: http://www.ada.gov/childqanda.htm. This report was reviewed and discussed with the applicant. All licensing reports are public information and must be made available upon request for at least three years.

A final application review will be made prior to licensing the facility.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura Chavez	TELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC809 (FAS) - (06/04)

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