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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500782
Report Date: 03/06/2023
Date Signed: 03/06/2023 11:15:29 AM

Document Has Been Signed on 03/06/2023 11:15 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:PEREGRINE SCHOOLFACILITY NUMBER:
574500782
ADMINISTRATOR:CORTEZ, GABRIELAFACILITY TYPE:
830
ADDRESS:2650 LILLARD DRIVETELEPHONE:
(530) 753-5500
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 0DATE:
03/06/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gabriela Valenzuela CortezTIME COMPLETED:
11:30 AM
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Application Specialist (AS) Alecia Sifuentes met with Licensee Representative/Director, Gabriela Valenzuela Cortez for the purpose of a prelicensing inspection. Director requests an infant license to serve 15 infant children from one to two years of age. The program will operate Monday through Friday from 7:30 a.m. to 5:30 p.m. Parents will meals, snacks, formula, breast milk, and baby food for their children.

AS reviewed with Director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. AS discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. AS also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

INDOOR ACTIVITY SPACE:
There is one infant classroom. AS observed a sufficient amount of equipment, toys, tables, chairs, high chairs, cubbies, and napping cots. There is a first aid kit in the classroom. Medications will be stored in the lobby in a locked box. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Director stated there will be a water pitcher and cups available in the classroom. AS observed a dual smoke and carbon monoxide detector in the lobby. AS observed an electronic sign-in/sign-out system.

Report continue on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: PEREGRINE SCHOOL
FACILITY NUMBER: 574500782
VISIT DATE: 03/06/2023
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AS measured the classroom. The total classroom space contains a total of 630 square feet, which will accommodate Director's request for 15 infant children. Director may order or convert the counter space into a changing table within arm's reach of a sink. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the sick bay/room and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one infant outdoor area on the property and is shared with the preschool children. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. There is no play structure. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by overhangs, rolling shades, and a seasonal canopy.

AS measured the outdoor activity space. The outdoor play area contains a total of 1,330 square feet, which will accommodate Director's request for 15 infant children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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

AS discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Director 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.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: PEREGRINE SCHOOL
FACILITY NUMBER: 574500782
VISIT DATE: 03/06/2023
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Director 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.

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 Director, Gabriela Valenzuela Cortez.

The following items are required before a license will be issued:
1. Remaining documents listed on the LIC184
2. Second prelicensing inspection
3. Granted fire clearance (STD850)
4. Final file review from Licensing Program Manager (LPM) Chayntel Hunter
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
LIC809 (FAS) - (06/04)
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