483005929-4-3-2025-01-CC-GOUE-DFDP5B-20250403110029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483005929
Report Date: 04/03/2025
Date Signed: 04/03/2025 11:00:38 AM

Document Has Been Signed on 04/03/2025 11:00 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	VUSD - FEDERAL TERRACE CDC - INFANT/TODDLER		FACILITY NUMBER:	483005929
ADMINISTRATOR/ DIRECTOR:	MONIQUE GARCIA		FACILITY TYPE:	830
ADDRESS:	415 DANIELS AVENUE		TELEPHONE:	(707) 556-8755
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY: 17	TOTAL ENROLLED CHILDREN: 17	CENSUS: 3	DATE:	04/03/2025
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Monique Garcia		TIME VISIT/ INSPECTION 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	Licensing Program Analyst (LPA) Glenn Ouye met with Site Supervisor Monique Garcia regarding an increase of capacity by one additional infant (from 5 to 6 infants). The toddler component will remain at 12 toddlers. The total capacity requested for this license is 18 children. The toddler program will remain in room 1, the infant program will use room 2 and the preschool children will utilize room 3. The application for the change in capacity was received on December 12, 2024. The approved fire clearance from the Vallejo Fire Department was received on January 21, 2025. Corinna Calica, who is the Coordinator Child Development Program asked if the capacity change could take place towards the end of the school year. The Child Development Program Coordinator and LPA Ouye agreed to inspect and approve the capacity change and room change on April 3, 2025 because the elementary school would be closed for spring break and it would have minimal impact on the preschool/infant and toddlers program operations. Room 1 is the toddler room. Room 1 has 860 square feet of indoor activity space for the toddlers. This will support the 12 toddlers. There are three toilets and three sinks for the toddler children. There is sufficient furniture, equipment and age appropriate toys for the toddlers. There is a functioning smoke and carbon monoxide detector and a charged fire extinguisher in the kitchen area.

NAME OF LICENSING PROGRAM MANAGER: Leslie Lepori
NAME OF LICENSING PROGRAM ANALYST: Glenn Ouye
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VUSD - FEDERAL TERRACE CDC - INFANT/TODDLER	FACILITY NUMBER: 483005929
	VISIT DATE: 04/03/2025

NARRATIVE

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Room two is the infant room. The infant room has sufficient indoor activity area for the 6 infants. There is 881 square feet of activity space for the infants. There is one changing table and a portable sink within arms reach for diaper changing. There is an additional sink which is used when there is food preparation. There is a refrigerator to store foods, breast milk and formula. There are sufficient cribs in the crib napping area which was not included as part of the 881 square feet of activity space. The napping area is separated from the activity area with a partition that varies between 4 to 5 feet tall and the top half of the partition is made with plexiglass for visual observation by the staff. There is sufficient furniture, equipment and age appropriate toys for the infants. The facility also has a six seat stroller to take the infants outdoors or for evacuation purposes.

There are functioning smoke and carbon monoxide detectors and a charged fire extinguisher.

The require posting are located just outside of the entry doors to each room.
The sign in and sign out's are done just inside the entry doors.

The capacity change is approved an effective on April 3, 2025. This approves the facility to have 6 infants and 12 toddlers.

NAME OF LICENSING PROGRAM MANAGER: Leslie Lepori
NAME OF LICENSING PROGRAM ANALYST: Glenn Ouye
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025

LIC809 (FAS) - (06/04)

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