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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500446
Report Date: 02/01/2023
Date Signed: 02/01/2023 10:46:43 AM

Document Has Been Signed on 02/01/2023 10:46 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:ROY, MICHELLEFACILITY TYPE:
850
ADDRESS:9424 BIG HORN BLVDTELEPHONE:
(916) 793-3671
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 120TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michelle RoyTIME COMPLETED:
11:00 AM
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Application Specialist (AS) Alecia Sifuentes met with Director, Michelle Roy for the purpose of a case management inspection. Licensee requests a decrease in capacity to serve 84 preschool children from 2 years to entry into kindergarten. The Licensee’s Alan Rowe Public Charter School will be utilizing some of the classrooms previously used by their preschool program. The program operates Monday through Friday from 7:00 a.m. to 6:00 p.m.

INDOOR ACTIVITY SPACE:
There are three preschool classrooms (2-4 years old room, 3-4 years old room, and 4-5 years old 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 2,961 square feet, which will accommodate licensee's request for 84 preschool children. There are 8 toilets and 8 sinks for the children. Director has requested a Shared Bathroom Waiver to utilize the elementary school's girls bathroom. There is a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There are two outdoor areas on the property. One outdoor area with the play structure is designated for the elementary school and the second outdoor area is designated for the preschool children. AS measured the preschool yard. The preschool yard contains a total of 7,282 square feet, which will accommodate licensee’s request for 84 preschool children.

Report continues LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: FORTUNE PRESCHOOL
FACILITY NUMBER: 344500446
VISIT DATE: 02/01/2023
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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.

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, Michelle Roy. 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.

The following items are required before the change of capacity will be approved:
1. Updated granted fire clearance (STD850)
2. Director’s health screening report
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC809 (FAS) - (06/04)
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