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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 090309074
Report Date: 07/26/2024
Date Signed: 07/26/2024 12:54:39 PM

Document Has Been Signed on 07/26/2024 12:54 PM - 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GEORGETOWN HEAD STARTFACILITY NUMBER:
090309074
ADMINISTRATOR/
DIRECTOR:		ENGLISH, MARIAFACILITY TYPE:
850
ADDRESS:6530 HARKNESS STREETTELEPHONE:
(530) 295-4515
CITY:GEORGETOWNSTATE: CAZIP CODE:
95634
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
07/26/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Jenny PettitTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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On 7/26/2024 at approximately 12:00pm, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat and LPA Soleil Marx met with Licensee Representative Jenny Pettit for the purpose of an announced change of capacity case management inspection. The Applicant is requesting a total of 24 preschool students and a room addition to the Gerogetown facility. The room being added to the facility is room 500. The fire clearance was received and granted. The program operates Monday through Friday 8:00 AM to 3:30 PM and it located on the Georgetown elementary school campus.

INDOOR ACTIVITY SPACE:
There are two portables building on site that are used by the facility. The classrooms are located in the Headstart room and room 500. During today's visit, LPAs observed a sufficient amount of equipment, toys, tables, chairs, nap mats, and cubbies in portable 500. LPA Manabat has requested that the facility representative send proof of classroom set up for the Headstart portable. CAB LPA measured the indoor space for a total of 1415.97 square feet, which will accommodate Licensee’s request for 24 preschoolers. There are a total of 6 sinks and 4 toilets. There is a private restroom for staff located inside both of the portables and are labeled as "adult bathroom".

OUTDOOR ACTIVITY SPACE:
There is currently one outdoor areas on site that is intended for use by the facility. Currently the outdoor play space is not fenced and could not be measured by LPA Manabat for the purpose of the case management inspection. The facility representative is aware that fencing that meets licensing regulations is required by the facility prior to licensure. The facility representative stated that she will contact the applicant, install fencing, and notify LPA Manabat when the area is ready for LPA review. During today's visit, LPA Manabat inspected the erected play structure and found that there is enough substrates underneath to cushion a fall. There is a play structure that is manufactured for ages 2-5 years of age present.

Report continues on LIC809-C....
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GEORGETOWN HEAD START
FACILITY NUMBER: 090309074
VISIT DATE: 07/26/2024
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Facility Representative stated there are no firearms, weapons, or bodies of water on the facility premises. LPAs observed a sufficient amount of shaded areas to the outdoor play area provided via trees.

Licensee Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Prior to issuing a license, the following conditions must be submitted:

1. Pending Licensing Program Manager's final review.
2. Proof of classroom set up in the Headstart classroom.
3. Proof of fencing and record of measurements for the area.

Exit interview conducted and report was reviewed with the Licensee Representative.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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