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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500446
Report Date: 04/11/2023
Date Signed: 04/11/2023 01:48:56 PM

Document Has Been Signed on 04/11/2023 01:48 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:FORTUNE PRESCHOOLFACILITY NUMBER:
344500446
ADMINISTRATOR:MICHELLE ROYFACILITY TYPE:
850
ADDRESS:9424 BIG HORN BOULEVARDTELEPHONE:
(916) 793-3671
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 0DATE:
04/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Michelle RoyTIME COMPLETED:
02:30 PM
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On 04/11/2023, Licensing Program Analyst Katy Maestas (LPA) conducted a field visit to the facility for the purpose of an unannounced annual inspection. LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA met with the Director Michelle Roy (D1). Although the facility has held a license for 1 year, children have not been in attendance due to a change in director, change of classrooms, flood, and a delay in furniture delivery. The intention of the facility is to begin accepting preschool aged children on 04/12/2023. LPA toured the facility inside and outside. LPA observed 0 children in attendance and 2 staff members. LPA accessed Guardian to verify that all required adults were background cleared. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. Facility's days and hours of operation are Monday-Friday from 7:00 AM to 6:00 PM. The facility provides breakfast, lunch and 2 snacks.

LPA conducted a file review prior to inspection and verified that annual fees were current. While on location, LPA reviewed and discussed care and supervision of children, staffing ratios, medications, first aid supplies, furniture, equipment, fire drills, and drinking water. LPA observed all required forms to be posted. There appear to be adequate toys and equipment available for children. LPA toured the outdoor play area, and D1 stated that children will not use the play structure as it is not age appropriate. D1 stated that bikes, chalk, balls, and other equipment will be brought outside for children to utilize during recess. D1 stated that tents have been purchased for an outside shade structure.

D1 stated that both electronic and paper sign-in procedures will be followed. LPA reviewed staff files but not children’s files as children have not begun to attend the program. LPA observed Health Screening Reports with TB test and required MMR and TDAP vaccines for all staff members. All staff members present today had current Pediatric CPR and First Aid. LPA observed current Mandated Reporter training for all staff. D1 was reminded to renew the course every 2 years.
Report continues on 809-C
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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: 04/11/2023
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This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/The training is currently provided in English and Spanish.

Incidental Medical Services (IMS) policy was discussed with D1. For IMS information, see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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.

D1 was reminded that all adults 18 and over, 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, 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.

If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

In the areas that were evaluated on 04/11/2023, no deficiencies were cited during today's inspection. LPA conducted an Exit Interview with D1 and the report was reviewed. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
LIC809 (FAS) - (06/04)
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