344500455-9-2-2021-53-CC-ASIS-C6GR7H-20210902124624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500455
Report Date: 09/02/2021
Date Signed: 09/02/2021 12:46:32 PM

Document Has Been Signed on 09/02/2021 12:46 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	LA PETITE ACADEMY		FACILITY NUMBER:	344500455
ADMINISTRATOR:	BECKSTROM, MICHELE		FACILITY TYPE:	840
ADDRESS:	8160 SHELFON ROAD		TELEPHONE:	(916) 684-4222
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY: 56	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	09/02/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Rosa Silva-Tichauer		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Application Specialist (AS) Alecia Sifuentes met with Licensee Representative, Rosa Silva-Tichauer for the purpose of an announced pre-licensing change of ownership inspection. Applicant requests a school-age license to serve 56 school-age children from kindergarten and above. The program will operate Monday through Friday from 6:30 a.m. to 6:00 p.m. The granted fire clearance was received on 8/26/2021. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat poster, menus, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. AS provided LIC311A, Effects of Lead Exposure brochure, and Healthy Schools Act survey. The facility will be providing afternoon snack during the school year and morning snack, lunch, and afternoon snack during holidays and summer. INDOOR ACTIVITY SPACE: There are two school-age classrooms. AS observed a sufficient amount of equipment, tables, chairs, and cubbies. There is a first aid kit in the classroom. Medications will be stored in the office in a locked box. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. AS observed a water pitcher and cups in the classroom. AS observed a functional carbon monoxide detector in all classrooms. AS observed an electronic sign-in/sign-out system. Report continues on 809-C.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: LA PETITE ACADEMY	FACILITY NUMBER: 344500455
	VISIT DATE: 09/02/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

AS measured two classrooms. The total classroom space contains a total of 1,970.19 square feet, which will accommodate Applicant's request for 56 school-age children. There are 4 toilets and 6 sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one school-age outdoor area and one indoor playground on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall and separates the school-age yard from the preschool yard. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by a small overhang. Applicant stated the facility will be installing a canopy to provide adequate shade for the school-age children.

AS measured the outdoor activity space and indoor playground. The total for both spaces is 3,578.89 square feet, which will only accommodate 47 school-age children. Applicant has requested a Shared Playground Waiver so the school-age children can utilize all preschool outdoor areas. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Incidental Medical Services and a Plan of Operation is located in the facility file. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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.

Report continues on 809-C.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: LA PETITE ACADEMY	FACILITY NUMBER: 344500455
	VISIT DATE: 09/02/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

AS discussed the following: supervision; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility evaluation report was reviewed and discussed with Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

AS will issue a provisional license that will expire in 90 days on 12/1/2021. Once the provisional is issued, the following items are to be submitted prior to expiration of the provisional license for final approval of license:

1. Remaining paperwork listed on LIC184.
2.Final file review from Licensing Program Manager (LPM) Jeanne Smith.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3