313624423-8-4-2022-03-CC-ABLI-CGYMSF-20220804095153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313624423
Report Date: 08/04/2022
Date Signed: 08/04/2022 09:52:17 AM

Document Has Been Signed on 08/04/2022 09:52 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:	CREEKSIDE OAKS ELEMENTARY PRESCHOOL		FACILITY NUMBER:	313624423
ADMINISTRATOR:	MENDOZA, DANIEL		FACILITY TYPE:	850
ADDRESS:	2030 1ST ST		TELEPHONE:	(530) 745-1380
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 0	DATE:	08/04/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Daniel Mendoza		TIME COMPLETED:	10:00 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	Licensing Program Analysts (LPAs) Amanda Blesi and Katrina Owens met with Licensee Representatives Daniel Mendoza for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 24 preschool children from two to five years of age. The facility operates on the Creekside Oaks Elementary School Campus in room K2. Hours of operation are Monday through Friday from 8:00 AM to 11:00 AM and 12:00 PM – 3:00 PM. INDOOR ACTIVITY SPACE: The classroom is equipped with child size furnishings and a sufficient number of cubbies for storing children's personal belongings. Facility operates two half day program and no naps will be offered. There is a refrigerator, a microwave, and a sink in the kitchen; snacks will be stored in the kitchen. LPAs observed the first aid kit. LPA observed functional water fountains, and a functional carbon monoxide detector. The classroom was measured. The classroom contains a total of 1418 square feet, which will accommodate the applicants' request for 24 preschool children. There are two toilets, and three sinks and staff will use the elementary school staff restroom. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the school office and will use the staff restroom if necessary. OUTDOOR ACTIVITY SPACE: A waiver request was submitted requesting shared use of the Kindergarten playground. Applicant understands that the preschool children may not use the playground at the same time as the kindergarten students. The outdoor activity space was measured. The outdoor play area contains a total of 6398 square feet, which will accommodate the applicant's request for 24 preschool children. The outdoor play areas is fenced and is equipped with age-appropriate equipment. There are shaded areas supplied by trees and awnings. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Report continues on 809-C.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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: CREEKSIDE OAKS ELEMENTARY PRESCHOOL	FACILITY NUMBER: 313624423
	VISIT DATE: 08/04/2022

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This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. A 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) 513-0301 (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.ht

The applicant was encouraged to 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.

LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates.

The following items are to be submitted prior to licensure:

1. An approved fire clearance.
2. A final review of the facility file will be conducted by LPA Blesi and LPM Keven Peters.

Exit interview conducted and report was reviewed with the facility representative, Daniel Mendoza.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC809 (FAS) - (06/04)

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