573619923-8-24-2023-53-CC-ASIS-CUZP22-20230824105513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573619923
Report Date: 08/24/2023
Date Signed: 08/24/2023 10:55:18 AM

Document Has Been Signed on 08/24/2023 10:55 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	PEREGRINE SCHOOL		FACILITY NUMBER:	573619923
ADMINISTRATOR:	GABRIELA CORTEZ		FACILITY TYPE:	850
ADDRESS:	2650 LILLARD DRIVE		TELEPHONE:	(530) 753-5500
CITY:	DAVIS	STATE: CA	ZIP CODE:	95618
CAPACITY:	90	CENSUS: 0	DATE:	08/24/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Gabriela Cortez		TIME COMPLETED:	11:30 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 Licensee Representative/Director Gabriela Valenzuela Cortez for the purpose of a case management inspection. Director is requesting a room change. Director is removing classroom #6 from the preschool program due to utilizing room #6 for the infant program. Licensee is not making any changes to the licensed capacity. The program currently operates Monday through Friday from 7:30 a.m. to 5:30 p.m. INDOOR ACTIVITY SPACE: There are four preschool classrooms located in rooms #2, #3, #4, and #5. There are two toddler option program classrooms located in rooms #1 and #1A. AS measured all six rooms. The total classroom space contains a total of 3,214 square feet, which will accommodate the current licensed capacity of 66 preschool children and 24 toddlers. There are six toilets and ten sinks for the children. There is a separate private restroom for the staff located near the front lobby down the hallway. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). OUTDOOR ACTIVITY SPACE: There is one preschool yard and one toddler yard. Director stated that the preschool children will be utilizing the infant yard so Director has requested a Shared Outdoor Space Waiver. Director stated that no changes have been made to the outdoor activity spaces. AS used current measurements from reports dated 8/23/2016 and 3/1/2019 therefore AS did not take measurements. The total outdoor activity spaces contains a total of 11,462 square feet, which will accommodate the current licensed capacity of 66 preschool children and 24 toddlers. 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: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PEREGRINE SCHOOL	FACILITY NUMBER: 573619923
	VISIT DATE: 08/24/2023

NARRATIVE

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Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Gabriela Valenzuela Cortez.

Effective today, 8/24/2023, AS will approve the room change.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC809 (FAS) - (06/04)

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