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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500446
Report Date: 12/09/2022
Date Signed: 12/09/2022 10:34:43 AM

Document Has Been Signed on 12/09/2022 10:34 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:FORTUNE PRESCHOOLFACILITY NUMBER:
344500446
ADMINISTRATOR:ESPINOZA, MAYRAFACILITY TYPE:
850
ADDRESS:9424 BIG HORN BLVDTELEPHONE:
(916) 793-3671
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 36TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/09/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Mayra EspinozaTIME COMPLETED:
10:45 AM
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Application Specialist (AS) Alecia Sifuentes and Licensing Program Analyst (LPA) Katy Maestas met with Director, Mayra Espinoza for the purpose of a change of capacity inspection. Licensee requests to serve 120 preschool children from 2 years to entry into kindergarten. The program operates Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance was granted and received on 11/15/2022.

INDOOR ACTIVITY SPACE:
There are four preschool classrooms, enrichment classroom, and an art room. AS observed a sufficient amount of equipment, toys, tables, chairs, nap mats, and cubbies. AS measured the classrooms. The total classroom space contains a total of 5,837 square feet, which will accommodate licensee's request for 120 preschool children. There are 8 toilets and 8 sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. AS used current outdoor measurements. The outdoor play area contains a total of 18,361 square feet, which will accommodate licensee’s request for 120 preschool children.

Director 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 LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: FORTUNE PRESCHOOL
FACILITY NUMBER: 344500446
VISIT DATE: 12/09/2022
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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 Director, Mayra Espinoza. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Effective today, 12/9/2022, AS will approve the change of capacity of 120 preschool children licensed to serve children from age 2 years to entry into kindergarten.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC809 (FAS) - (06/04)
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