313623889-4-21-2021-03-CC-SDLA-C2AMG9-20210421093535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623889
Report Date: 04/20/2021
Date Signed: 04/21/2021 09:35:41 AM

Document Has Been Signed on 04/21/2021 09:35 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	KIDS' PLACE, THE		FACILITY NUMBER:	313623889
ADMINISTRATOR:	BROWN, MARIAH		FACILITY TYPE:	850
ADDRESS:	1115 COMBIE RD		TELEPHONE:	(530) 878-7875
CITY:	MEADOW VISTA	STATE: CA	ZIP CODE:	95722
CAPACITY: 11	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	04/20/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jessica Garofalo		TIME COMPLETED:	12:30 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) Seychelle De Luca and Licensing Program Analysts (LPA) Alize Tillery met with Applicant Jessica Garofalo for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Applicant requests a preschool license to serve 11 preschool children from age two to entry into kindergarten. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 3/25/2021. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, Effects of Lead Exposure brochure, menus, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. The facility will provide morning snack, lunch, and afternoon snack. INDOOR ACTIVITY SPACE: There is one preschool classroom. AS and LPA observed a sufficient amount of equipment, toys, tables, chairs, napping cots, and cubbies. There is a first aid kit in preschool classroom. AS and LPA observed cleaning disinfectants and medications are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated children bring water bottles and there are extra cups and a cooler available. AS and LPA observed a functional carbon monoxide detector in the crib area. Applicant stated the facility will use a paper sign-in/sign-out system. Report continues on 809-C.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Seychelle De Luca
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021

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: KIDS' PLACE, THE	FACILITY NUMBER: 313623889
	VISIT DATE: 04/20/2021

NARRATIVE

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Applicant measured the classroom; and AS walked her through the measuring process. The total classroom space contains a total of 393.69 square feet, which accommodates Applicant's request for 11 preschool children. There is one toilet and one sink 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 and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor play area for infant children. The play space is surrounded by a chain link fence that is at least four feet tall. The play space will be shared by preschool and infant children; Applicant already submitted a shared outdoor space waiver request. AS and LPA did not observe a sufficient amount of equipment and toys. There is a shaded area supplied by a pop-up tent. There is a climbing structure that Applicant stated it anchored into the ground. Applicant acknowledges staff must ensure children use age-appropriate equipment at all times.

Applicant measured the outdoor space; and AS walked her through the measuring process. The outdoor play area contains a total of 1990.86 square feet, which accommodates Applicant's request for 11 children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the preschool file. 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.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Seychelle De Luca
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021

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: KIDS' PLACE, THE	FACILITY NUMBER: 313623889
	VISIT DATE: 04/20/2021

NARRATIVE

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AS discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; criminal record clearances, 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 directors 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.

This facility evaluation report was reviewed and discussed with Applicant. AS emailed a copy of the 809 to Applicant. Applicant understands she must reply that she received, read, and understands the report. AS provided LIC311A, Effects of Lead Exposure brochure, and immunization card.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. A final review of the file by Licensing Program Manager (LPM) Keven Peters.
2. Proof more outdoor equipment has been ordered.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Seychelle De Luca
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021

LIC809 (FAS) - (06/04)

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