343624247-4-22-2022-03-CC-MLOR-CDQRRY-20220422131554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624247
Report Date: 04/22/2022
Date Signed: 04/22/2022 01:16:04 PM

Document Has Been Signed on 04/22/2022 01:16 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	EXCELSIOR PRESCHOOL GOLD RIVER LLC		FACILITY NUMBER:	343624247
ADMINISTRATOR:	FUGATE, NANCY		FACILITY TYPE:	850
ADDRESS:	2317 GOLD MEADOW WAY		TELEPHONE:	(916) 730-8757
CITY:	GOLD RIVER	STATE: CA	ZIP CODE:	95670
CAPACITY:	118	CENSUS: 0	DATE:	04/22/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Nancy Fugate		TIME COMPLETED:	01:30 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) Mai Lor met with Facility Representative Nancy Fugate for the purpose of an announced pre-licensing. Applicant request a preschool license to serve 118 preschool children from age two to entry into first grade. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 03/22/2022. AS reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule. Applicant stated the facility will provide AM/PM snack, and a lunch. INDOOR ACTIVITY SPACE: There are four classrooms. AS observed sufficient amount of age- appropriate equipment, toys, tables, and cubbies. There is a kitchen to support the food service equipped with a stove and refrigerator. There is a first aid kit in each classroom. Applicant stated medications will stored in the kitchen. Applicant stated there are no firearms or weapon on the premises. Applicant stated indoor and outdoor drinking water will be provided via water pitchers with individualized water bottles. AS observed carbon monoxide detectors throughout the facility. AS observed an electronic sign-in/sign-out system. AS measured all four classrooms. The total classroom space contains a total of 4158.40 square feet, which will accommodate the requested capacity for 118 preschool children. There are 10 toilets and 15 sinks available for children to use in the facility. There is a separate private restroom for the staff. (Report continued on subsequent LIC 809)

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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: EXCELSIOR PRESCHOOL GOLD RIVER LLC	FACILITY NUMBER: 343624247
	VISIT DATE: 04/22/2022

NARRATIVE

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Children who become ill during the day will be isolated in the office and will use the staff restroom or use the single restroom with a door located in classroom #4 (K-Prep), if necessary. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There are two outdoor activity space for preschool children. The outdoor play area is surrounded by a fence that is at least four feet tall. The first preschool playground located in the back of the facility has two play structures (general climbing structure and a train play structure) that are anchored to the ground. AS observed safety labels on both structures; however, only the general climbing structure has an age label of 2-12 years old. AS reminded facility representative to follow safety labels per climbing structure. AS observed poured in placed rubber used as cushioned under climbing structures. AS observed shade structure, trees and overhangs utilized as shade.

The second outdoor space contained a play house and no play structure. It is shaded by overhangs and trees. AS observed sufficient amount of age appropriate equipment and toys. Applicant was reminded that children are to use age appropriate toys and equipment.

AS measured the outdoor space. The outdoor play area contains a total of 10,837.69 square feet, which will accommodate Applicant's request for 118 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

AS discussed the following: 100% supervision is required at all times; personal rights; 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 director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) 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 continued on subsequent LIC 809)

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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: EXCELSIOR PRESCHOOL GOLD RIVER LLC	FACILITY NUMBER: 343624247
	VISIT DATE: 04/22/2022

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant 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.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following items are required before a license will be issued:

1. Financial verification

2. Pending Licensing Program Manager’s final review

Exit interview conducted and report was reviewed with the Facility Representative, Nancy Fugate.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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