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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625415
Report Date: 02/01/2024
Date Signed: 02/27/2024 04:07:38 PM

Document Has Been Signed on 02/27/2024 04:07 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WILD ROSE MONTESSORI PRESCHOOLFACILITY NUMBER:
343625415
ADMINISTRATOR:AMY KHOJAFACILITY TYPE:
850
ADDRESS:4421 A STREETTELEPHONE:
(510) 717-4478
CITY:SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 0DATE:
02/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amy Khoja and Lucia CruzTIME COMPLETED:
12:00 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat and Alecia Sifuentes met with the Applicant Amy Khoja and Assistant Director Lucia Cruz for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 48 preschool children from age two years to entry into first grade. The program will operate Monday through Friday from 7:30 a.m. to 5:00 p.m. The facility will provide morning and afternoon snacks. The facility requests that lunches should be brought from home. LPAs 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.

INDOOR ACTIVITY SPACE:
There are two preschool classrooms in Rooms 1 (Casa Bambini) and 2 (Casa Armici). LPAs observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping mats. LPAs discussed the importance of using one side of the mat for sleeping and one designated for the ground. There is a first aid kit in each of the classrooms. Medications will be stored in the classrooms in a locked cabinet. LPAs observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPA Manabat discussed the importance of storing any poisons in a locked area with either a combination or a key lock. LPAs observed a functional carbon monoxide detector in the classroom. LPAs discussed the sign-in/sign-out system with the Director and Licensee Representative. They stated that they will use the ProCare.

LPA measured the classrooms. The total classroom space contains a total of 1,777 square feet, which will accommodate Applicant's request for 48 preschool children. There are 4 toilets and 4 sinks located between Room 1, 2, and the bathroom. LPA observed a separate private restroom for the staff located in the office building. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.
Report continues on LIC809-C.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WILD ROSE MONTESSORI PRESCHOOL
FACILITY NUMBER: 343625415
VISIT DATE: 02/01/2024
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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a chain-linked fence that is at least four feet tall. There is shade provided by a canopy. During today's inspection, LPAs did not observe a play structure. Water is being provided by water bottles that can be refilled by a water jug. There are sufficient amount of equipment and toys. There are no bodies of water on the premises. LPAs observed that there is a locked shed on the premises that will house garden tools and substrates that will be used for gardening. LPA Manabat advised that this should be locked at all times and that children should not have access to the shed. The key to the shed will be stored in an area inaccessible to the children. LPA also advised that any fertilizer or gardening chemicals shall not be left out after they are used by staff and that they should be stored back in the shed immediately.

LPA measured the outdoor activity space. The outdoor play area contains a total of 3,602 square feet, which will accommodate 48 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

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) or (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

LPAs discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPAs 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.

Report continues on LIC809-C.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WILD ROSE MONTESSORI PRESCHOOL
FACILITY NUMBER: 343625415
VISIT DATE: 02/01/2024
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Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

Exit interview conducted and report was reviewed with the Applicant, Amy Khoja and Assistant Director Lucia Cruz.

The following items are required before a license will be issued:
1. Final file review from Licensing Program Manager (LPM) Mai Lor
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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