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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500446
Report Date: 06/17/2024
Date Signed: 06/17/2024 11:36:38 AM

Document Has Been Signed on 06/17/2024 11:36 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:FORTUNE PRESCHOOLFACILITY NUMBER:
344500446
ADMINISTRATOR/
DIRECTOR:
MICHELLE ROYFACILITY TYPE:
850
ADDRESS:9424 BIG HORN BOULEVARDTELEPHONE:
(916) 793-3671
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 14DATE:
06/17/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Michelle RoyTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 06/17/2024, Licensing Program Analyst Katy Velazquez (LPA1) and Centralized Application Bureau (CAB) Licensing Program Analyst Alecia Sifuentes (LPA2) conducted a Licensee initiated Case Management inspection for the purpose of a room change. LPAs arrived at the facility and were met by Director Michelle Roy (D1). LPAs disclosed the purpose of the inspection and were granted entrance into the facility. A Fire Clearance was granted and received by the Department on 06/14/2024. The current hours of operation are Monday thru Friday 7:00 am until 6:00 pm.

INDOOR ACTIVITY SPACE:
The program is adding 2 classrooms due to construction. LPAs observed a total of 5 sinks in the classrooms. A shared bathroom waiver is on file with the Department. LPAs inspected the bathroom and observed 6 toilets and 4 sinks. LPAs observed the facility has a total of 6 toilets and 9 sinks. This is sufficient to meet the needs of 84 preschool aged children. The facility’s capacity is 84 preschool aged children. Licensee is not making a change to the licensed capacity. LPAs used the current classroom measurements for classrooms 1, 3 and 5. LPAs measured classrooms 12 and 14. The classrooms contain a total measurement of 4752 square feet which is enough to accommodate the licensed capacity of 84 preschool aged children. Individual measurements are recorded on the Capacity Worksheet LIC 9024.

LPA1 is approving the use of classrooms 12 and 14 once an amended 850 to include all classrooms is received from Consumnes Fire Department. No deficiencies were cited today in the areas that were evaluated. An exit interview was conducted, and the report was reviewed with Director Roy. Licensee Appeal Rights were provided by LPA1. A Notice of Site visit was posted by LPA1 and must remain posted for 30 days. Failure to comply with posting requirements will result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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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