343621336-10-3-2023-53-CC-ASIS-CW9MA7-20231003092551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343621336
Report Date: 10/03/2023
Date Signed: 10/03/2023 09:25:55 AM

Document Has Been Signed on 10/03/2023 09:25 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:	SETA - WALNUT GROVE HEAD START		FACILITY NUMBER:	343621336
ADMINISTRATOR:	GONZALEZ, JUANA		FACILITY TYPE:	850
ADDRESS:	14181 GROVE STREET		TELEPHONE:	(916) 263-3737
CITY:	WALNUT GROVE	STATE: CA	ZIP CODE:	95690
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 21	CENSUS: 20	DATE:	10/03/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Betsy Uda		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	Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Head Start Manager Betsy Uda for the purpose of a case management inspection. Licensee requests a change of capacity to serve 24 children from age 2 years to entry into kindergarten and 9 toddlers age 18-36 months under the Toddler Option Program. The preschool program is located at Walnut Grove Elementary. The fire clearance was received and granted on 9/22/2023. The program operates Monday through Friday from 8:00 a.m. to 2:30 p.m. INDOOR ACTIVITY SPACE: There is one preschool classroom located in Room #1 and one toddler classroom located in Room #6. CAB LPA observed a sufficient amount of equipment, toys, tables, chairs, nap mats, and cubbies. CAB LPA used current indoor measurements from report dated 9/7/2016, therefore CAB LPA did not take measurements. The total indoor space contains a total of 1,748 square feet, which will accommodate Licensee’s request for 24 preschool children and 9 toddlers. There is one toilet and two sinks located in Room #6 and one sink located in Room #1. CAB LPA observed a Shared Bathroom Waiver on file and posted allowing the preschool children to utilize the elementary school’s restroom. OUTDOOR ACTIVITY SPACE: There is one outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall and separates the preschool yard from the elementary school yard. AS observed a sufficient amount of equipment and toys. The play structure includes a safety label, which designates use for children 2 to 5 years old. Licensee understands that children under the age of two years cannot use the play structure. There are no bodies of water on the premises. There are shaded areas supplied by a canopy located towards the left of the play structure. Report continues on LIC809-C.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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: SETA - WALNUT GROVE HEAD START	FACILITY NUMBER: 343621336
	VISIT DATE: 10/03/2023

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CAB LPA used current outdoor measurements from report dated 9/7/2016, therefore CAB LPA did not take measurements. The outdoor play area contains a total of 2,054 square feet, which will accommodate Licensee’s request for 24 preschool children and 9 toddler children. CAB LPA observed an Insufficient Outdoor Space Waiver on file and posted which is no longer valid. Licensee has requested a Shared Outdoor Space Waiver and has provided an outdoor schedule indicating when the toddlers and preschool children will go outside showing no commingling between the groups.

Licensee 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.

Exit interview conducted and report was reviewed with the Head Start Manager, Betsy Uda.

Effective today, 10/3/2023, CAB LPA will approve the change of capacity to serve 24 children from age 2 years to entry into kindergarten and 9 toddlers age 18-36 months under the Toddler Option Program.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC809 (FAS) - (06/04)

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