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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500446
Report Date: 12/15/2023
Date Signed: 12/15/2023 01:25:53 PM

Document Has Been Signed on 12/15/2023 01:25 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 20DATE:
12/15/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Michelle RoyTIME COMPLETED:
02:15 PM
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Centralized Application Bureau (CAP) Licensing Program Analyst Alecia Sifuentes (LPA1) and Licensing Program Analyst Katy Velazquez (LPA2) met with Director, Michelle Roy for the purpose of a case management inspection. Licensee requests a room change. Licensee is not changing the capacity. 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 located in classroom #1, 3-4 years old located in clasroom #3, and 4-5 years old located in classroom #2). Licensee has moved the 4-5 year old classroom to classroom #5. LPAs observed sufficient amount of equipment, toys, tables, chairs, nap mats, and cubbies. LPAs measured the classroom #5. The total classroom spaces contains a total of 2,966 square feet, which will accommodate the current capacity for 84 preschool children. There are 8 toilets and 8 sinks for the children. LPA observed a Shared Bathroom Waiver on file 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).

Licensee 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.

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.

Exit interview conducted and report was reviewed with the Director Michelle Roy.

Effective today, 12/15/2023, LPAs will approve the room change.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
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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