343624402-1-13-2023-03-CC-ATIY-CN2QT5-20230113112634

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624402
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:26:45 AM

Document Has Been Signed on 01/13/2023 11:26 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:	HAGGINWOOD ACADEMY		FACILITY NUMBER:	343624402
ADMINISTRATOR:	DAVIS, TRACEY MICHELLE		FACILITY TYPE:	850
ADDRESS:	3240 MARYSVILLE BLVD.		TELEPHONE:	(916) 696-7575
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95815
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 0	DATE:	01/13/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Tracey Davis		TIME COMPLETED:	11:45 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 Analyst (LPA) Alize Tillery met with Applicant Tracey Davis and Director Olga Rotar for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 12 preschool children from ages two to five years. There were no children present during today’s inspection. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 7/18/2022. Program will not offer transportation services. LPA 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 breakfast, lunch, and two snacks. INDOOR ACTIVITY SPACE: There are 2 classrooms: Kinder Prep and Early Learners. There is a third room, closest to the outdoor playground, that was previously used as an infant room for the previous Licensees. This room is currently not for Preschool use. LPA observed sufficient amount of age-appropriate equipment, toys, tables, chairs, and cubbies. There is a kitchen to support the food service equipped with a stove, refrigerator, dish washer and washer and dryer. Applicant will purchase a first aid kit for the facility. LPA observed cleaning disinfectants appropriately stored. Applicant stated medications will be stored in the office. Applicant stated there are no firearms on the premises. Applicant stated there will be filtered water pitchers and disposable cups available in the classroom. Applicant needs to purchase a carbon monoxide detector. LPA observed facility’s smoke detector and fire extinguisher. LPA observed the facility’s paper sign in and sign out system near the front desk. (Report continues on subsequent LIC 809)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: HAGGINWOOD ACADEMY	FACILITY NUMBER: 343624402
	VISIT DATE: 01/13/2023

NARRATIVE

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With the assistance of Applicant and Director, LPA measured both active rooms. The total classroom space contains a total of 775.3833 square feet, which will accommodate the requested capacity of 12 preschool children. The facility has a total of 2 sinks and 2 toilets available for children. There is a separate private restroom for the staff. Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
The outdoor play area is surrounded by a fence that is at least four feet tall. There is one non-anchored play structure on the playground. LPA confirmed that the play structure is age appropriate for children ages 2 to 6 years. Applicant was encouraged to obtain a safety label that includes manufacturer guidelines, if available. LPA observed sufficient amount of age-appropriate equipment and toys. Applicant stated that they have a large overhang for shade. LPA observed artificial grass used as cushioned under the play structure.

LPA measured the outdoor activity space. The outdoor play area contains a total of 1009.598 square feet, which will accommodate Applicant's request for 12 preschool children. The facility will provide drinking water via water pitcher and disposable cups, outdoors as well. ,

LPA 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. LPA 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 continues on subsequent LIC 809)

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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: HAGGINWOOD ACADEMY	FACILITY NUMBER: 343624402
	VISIT DATE: 01/13/2023

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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. Carbon monoxide installed

2. First aid kit purchased

3. Menu and schedule posted

4. Updated facility sketch

Exit interview conducted and report was reviewed with Applicant, Tracey Davis.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Alize Tillery
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

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