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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500485
Report Date: 08/25/2021
Date Signed: 08/25/2021 11:00:42 AM

Document Has Been Signed on 08/25/2021 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:YCOE MARGUERITE MONTGOMERYFACILITY NUMBER:
574500485
ADMINISTRATOR:GENET TELAHUN/SILVIA MEZAFACILITY TYPE:
850
ADDRESS:1441 DANBURY STREETTELEPHONE:
(530) 668-3010
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/25/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Gail Nadal, Maria Cardenas, Silvia Meza-LaraTIME COMPLETED:
11:30 AM
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Application Specialist (AS) Alecia Sifuentes and Licensing Program Analyst (LPA) Chayntel Hunter met with Program Director Gail Nadal, Administrative Secretary Maria Cardenas, Site Supervisor Silvia Meza-Lara for the purpose of an announced pre-licensing change of location inspection. Applicant requests a preschool license to serve 48 preschool children from age two to five years. The program will operate Monday through Friday from 7:30 a.m. to 4:30 p.m. The fire clearance was received and granted on 8/25/2021.

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. The facility will provide morning snack, lunch, and afternoon snack.

INDOOR ACTIVITY SPACE:
There are two preschool classrooms in E3 and E4. AS observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit wall box located in each classroom. Medications will be stored in medication cabinet located in each classroom. 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 dispenser located in each classroom. AS observed a functional dual carbon monoxide and smoke detector in each classroom. AS observed sign-in/sign-out binders.

Report continues on 809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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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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: YCOE MARGUERITE MONTGOMERY
FACILITY NUMBER: 574500485
VISIT DATE: 08/25/2021
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AS measured two classrooms. The total classroom space contains a total of 1,823 square feet, which will accommodate Applicant's request for 48 preschool children. There are 5 toilets and 4 sinks for the children, and a separate private restroom for the staff. Applicant stated that the preschool children will be sharing the restrooms with the elementary school children. Applicant has requested a shared bathroom waiver. 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 outdoor area on the property. The outdoor play area is currently fenced with temporary fencing that is at least four feet tall and fully surrounds the play yard. Applicant stated the permanent fencing is delayed do due shipping. Applicant will provide AS with photos of the permanent fencing once installed. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees.

AS measured the outdoor activity space. The outdoor play area contains a total of 3,669 square feet, which will accommodate Applicant's request for 48 preschool children. 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: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
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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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: YCOE MARGUERITE MONTGOMERY
FACILITY NUMBER: 574500485
VISIT DATE: 08/25/2021
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AS discussed the following: 100% supervision is required at all times, including in the bathroom; 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 11/23/2021. 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. Proof of permanent playground fencing.
2. Final file review from Licensing Program Manager (LPM) Justin Denton.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
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