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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343627203
Report Date: 08/21/2025
Date Signed: 08/21/2025 11:11:42 AM

Document Has Been Signed on 08/21/2025 11:11 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SCUSD NICOLASFACILITY NUMBER:
343627203
ADMINISTRATOR/
DIRECTOR:		ROSELI, CHRISTINAFACILITY TYPE:
850
ADDRESS:6601 STEINER DRIVETELEPHONE:
(916) 643-7800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/21/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Christina Roseli & Melanie LorTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the facility representative, Christina Roseli, for a scheduled pre licensing inspection. The facility applied for a preschool license with maximum of 24 children (ages from three to five). The preschool will be located on Nicholas elementary school site in Room B101. A fire inspection was conducted on August 13, 2025 and clearance was granted.

During today’s inspection, LPA inspected the classroom, bathroom and play yard. LPA observed that the classroom has age appropriate furniture. Furniture is steady and in good repair. Classroom has sprinkler system on the ceiling, there is combination Smoke and Carbon monoxide detector installed. There are first aid supplies and working telephone on site. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. There are sleeping matts available for the children. There is one sink inside the classroom and two sinks next to the bathrooms. There are two Bathrooms and both bathrooms have one toilet each. During inspection, LPA also measured the classroom and play yard. Based on the measurements taken today, the total indoor space of the new classroom is 996.04 square feet which will accommodate requested capacity of 24 children in care.

During inspection, LPA inspected the outdoor/play space for the children. LPA observed that there are two drinking water fountains in the play yard. There is play structure in play yard with shade, but manufacture stickers on the play structure restricts the play structure for children with age group of five to twelve. Therefore, the facility representative agreed that the play structure will not be used for children from this facility.
See next page for continuation ..............
NAME OF LICENSING PROGRAM MANAGER: Jeevun Birk-Miller
NAME OF LICENSING PROGRAM ANALYST: Gagandeep Singh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: SCUSD NICOLAS
FACILITY NUMBER: 343627203
VISIT DATE: 08/21/2025
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Per facility representative, the facility will barricade the area of play structure to keep it inaccessible. LPA observed there are circular tables with bench in the play yard, which are age appropriate for children. Facility representative agreed to have umbrella installed on the tables to provide shaded area for the children, as shaded area in play structure area will be barricaded. During inspection, facility representative informed LPA that TK and Kindergarten children from the school will also use the same play yard, but at different times than preschool program. During inspection, LPA measured the area of play yard, which is in front of the classroom. Based on the measurements, it was found that the play yard will have 6860 square feet of space available for children, which meets the requirement for requested capacity.

During inspection, LPA answered the licensing questions and obtain some of the needed documentation. However, following items are required before a license will be issued:

-Facility will submit the request of wavier to share play yard with the school.
-Facility will barricade the play structure to make it inaccessible for children.
-Facility will install or provide the shaded area in play yard for children.
-Provide the Health and safety course completion certificate and Measles documentation for assigned director.
- Licensing Program Manager’s final review.

Copy of this report was reviewed and provided to the facility representative, Melanie Lor.
NAME OF LICENSING PROGRAM MANAGER: Jeevun Birk-Miller
NAME OF LICENSING PROGRAM ANALYST: Gagandeep Singh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC809 (FAS) - (06/04)
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