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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500782
Report Date: 12/19/2024
Date Signed: 12/19/2024 12:10:56 PM

Document Has Been Signed on 12/19/2024 12:10 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:PEREGRINE SCHOOLFACILITY NUMBER:
574500782
ADMINISTRATOR/
DIRECTOR:		CORTEZ, GABRIELAFACILITY TYPE:
830
ADDRESS:2650 LILLARD DRIVETELEPHONE:
(530) 753-5500
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 6DATE:
12/19/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Gabriela CortezTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Director/Licensee Representative Gabriela Valenzuela Cortez for the purpose of a case management inspection. Licensee requests an increase in capacity for 16 infants ages 0-24 months. The fire clearance (STD850) was granted and received on 12/5/2024. The program currently operates Monday through Friday from 7:30 a.m. to 5:30 p.m.

INDOOR ACTIVITY SPACE:
There is one infant classroom located in Room #5 and an infant crib room located in Room #6. LPA observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and three cribs set up. Director stated that they have an additional five cribs available for a total of eight cribs. LPA measured infant classroom #5. The total classroom space contains a total of 563 square feet, which will accommodate Licensee’s request for 16 infants. There is one sink located in the Room #5 and one sink located in Room #6. LPA observed a diaper changing mat on top of the sink counter in Room #5. Director stated that the sink area is being converted into a diaper changing table/area. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. LPA used current measurements from report dated 8/24/2023, therefore LPA did not take measurements. The outdoor activity space contains a total of 1,720 square feet, which will accommodate Licensee’s request for 16 infants.

Director was reminded that all adults 18 and over, 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: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2024
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PEREGRINE SCHOOL
FACILITY NUMBER: 574500782
VISIT DATE: 12/19/2024
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A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Gabriela Valenzuela Cortez.

The following items are required before the change of capacity will be approved:

1. Photo of crib room #6 completed.

2. Photo of infant activity space room #5 completed.

3. Photo of diaper changing table within arm's reach of a sink with a 3 inch lip.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC809 (FAS) - (06/04)
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