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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500446
Report Date: 03/24/2022
Date Signed: 03/24/2022 11:30:21 AM

Document Has Been Signed on 03/24/2022 11:30 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:FORTUNE SCHOOL OF EDUCATION-FORTUNE PRESCHOOLFACILITY NUMBER:
344500446
ADMINISTRATOR:FORTUNE, MARGARETFACILITY TYPE:
850
ADDRESS:9424 BIG HORN BLVDTELEPHONE:
(916) 684-0100
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 36TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/24/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tenaya WoodsTIME COMPLETED:
12:00 PM
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Application Specialist (AS) Alecia Sifuentes and met with Director, Tenaya Woods for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 36 preschool children from age two to four years old. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance was granted and received on 7/19/2021. The facility will provide breakfast, morning snack, lunch, and afternoon snack.

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.

INDOOR ACTIVITY SPACE:
There are two preschool classrooms, enrichment classroom, and atelier classroom (art room). Director stated the equipment, toys, cubbies, and napping cots are being ordered and will provide AS with proof of order. There is a first aid kit in each of the classrooms and front desk. Medications will be stored in the directors. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Director stated the children will be provided water using water cups and water dispenser. AS observed a functional carbon monoxide detector in the front lobby. Director stated the facility will have both paper and electronic sign-in/sign-out system.

AS measured four classrooms. The total classroom space contains a total of 3,892 square feet, which will accommodate applicant's request for 36 preschool children. There are 8 toilets and 6 sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the isolation area and will use the staff restroom, if necessary.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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: FORTUNE SCHOOL OF EDUCATION-FORTUNE PRESCHOOL
FACILITY NUMBER: 344500446
VISIT DATE: 03/24/2022
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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall. AS observed an opening at the front of the playground making the outdoor space not fully fenced. Director stated that a fence gate has been ordered and will show proof of installation. Director stated the equipment and toys are being ordered and will provide AS with proof of order. The play structure includes a safety label, which designates use for children 5 to 12 years old. AS informed the Director that the children cannot utilize the play structure. There are no bodies of water on the premises. There are shaded areas supplied by trees.

AS measured the outdoor activity space. The outdoor play area contains a total of 18,361 square feet, which will accommodate applicant's request for 36 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)/ (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

AS 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. 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.

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, 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.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
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: FORTUNE SCHOOL OF EDUCATION-FORTUNE PRESCHOOL
FACILITY NUMBER: 344500446
VISIT DATE: 03/24/2022
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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 Director, Tenaya Woods.

The following items are required before a license will be issued:
1. Proof of classroom and outdoor equipment order and delivery date.
2. Proof of fence gate installation.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
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