344500712-11-25-2022-53-CC-ASIS-CKLNUL-20221027104630

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 344500712
Report Date: 10/27/2022
Date Signed: 11/25/2022 10:23:29 AM

Document Has Been Signed on 11/25/2022 10:23 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:	ELK GROVE KIDS CAMP		FACILITY NUMBER:	344500712
ADMINISTRATOR:	AMALI, KIMBERLY		FACILITY TYPE:	840
ADDRESS:	9360 ELK GROVE FLORIN RD STE 4		TELEPHONE:	(916) 685-7462
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/27/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kim Amali		TIME COMPLETED:	10:30 AM

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 applicant/Licensee Representative, Kim Amali for the purpose of an announced pre-licensing inspection. Applicant requests a school-age license to serve 28 school-age children from kindergarten and above. The program will operate Monday through Friday from 8:00 a.m. to 5:00 p.m. There is another business, Sunshine Swim Center located at the same address that is owned and operating by Kim Amali. Kim stated the swim business will not have access to the classroom, outdoor activity area, and children’s bathrooms during the operating hours of the child care program. The fire clearance was granted and received on 10/27/2022. The facility will not be offering meals. Parents will provide snack and meals. AS reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. INDOOR ACTIVITY SPACE: There is one school-age classroom. AS observed a sufficient amount of equipment, tables, and chairs. There is a first aid kit in the classroom. Facility will not be assisting with medication. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. AS observed a water faucet and individual water bottles in the classroom. AS observed a functional carbon monoxide detector in the classroom. AS observed a sign-in/out binder. AS measured one classroom. The total classroom space contains a total of 3,942 square feet, which will accommodate applicant's request for 28 school-age children. There are 4 toilets/2 urinals and 4 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 near the front of the classroom and will use the staff restroom, if necessary. Report continues on LIC809-C.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ELK GROVE KIDS CAMP	FACILITY NUMBER: 344500712
	VISIT DATE: 10/27/2022

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

OUTDOOR ACTIVITY SPACE:
There is one school-age outdoor area on the property. The outdoor play area is fenced with a wrought iron fence and cinder block wall that is at least four feet tall. There are shaded areas supplied by canopies. AS observed a pool on the premises. AS observed a five-foot-tall wrought iron fence that separates the classroom door and outdoor space door from the pool area. AS observed that the fence gate swings away from the pool and self-latches. AS observed pool chemicals locked in the storage area.

AS measured the outdoor activity space. The outdoor play area contains a total of 2,256 square feet, which will accommodate applicant's request for 28 school-age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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.

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.

Applicant 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.

Report continues on LIC809-C.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ELK GROVE KIDS CAMP	FACILITY NUMBER: 344500712
	VISIT DATE: 10/27/2022

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

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 the applicant, Kim Amali.

The following items are required before a license will be issued:
1. Final file review from Licensing Program Manager (LPM) Bettina Engelman

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3