574500901-7-6-2023-53-CC-ASIS-CTGPEB-20230706111452

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 574500901
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:12:39 PM

Document Has Been Signed on 07/06/2023 02:12 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:	SOUTHPORT ELEMENTARY		FACILITY NUMBER:	574500901
ADMINISTRATOR:	ATABAKI, RAHELE		FACILITY TYPE:	850
ADDRESS:	2747 LINDEN RD		TELEPHONE:	(916) 375-7890
CITY:	WEST SACRAMENTO	STATE: CA	ZIP CODE:	95691
CAPACITY: 16	TOTAL ENROLLED CHILDREN: 5	CENSUS: 0	DATE:	07/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Rahele Atabaki		TIME COMPLETED:	11:35 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 Director of Early Childhood Education Rahele Atabaki for the purpose of an announced change of location inspection. Licensee requests a capacity of 18 preschool children age two to entry into kindergarten. The program will operate Monday through Friday from 11:30 a.m. to 2:30 p.m. The facility will provide lunch and afternoon snacks. 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. INDOOR ACTIVITY SPACE: There is one preschool classroom located in Room 4. AS observed a sufficient amount of equipment, toys, tables, chairs, and cubbies. There is a first aid kit in the classroom cabinet. Medications will be stored in the nurses office. 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 fountain in the classroom. AS observed a dual smoke and functional carbon monoxide detector in the classroom. AS observed an electronic sign-in/sign-out system. AS measured classroom 4. The total classroom space contains a total of square feet, which will accommodate Licensee's request for 18 preschool children. There are two toilets and two sinks for the children, and a separate private restroom for the staff. Both toilets and one sink is located in the elementary school bathroom. Director 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 nurses office 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: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SOUTHPORT ELEMENTARY	FACILITY NUMBER: 574500901
	VISIT DATE: 07/06/2023

NARRATIVE

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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. The outdoor space is shared with the transitional kindergarten children. Director has requested a Shared Outdoor Space Waiver. AS observed a sufficient amount of equipment and toys. The play structure includes a safety label, which designates use for children 2 to 5 years old. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

AS measured the outdoor activity space. The outdoor play area contains a total of 7,089 square feet, which will accommodate Licensee's request for 18 preschool 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) or (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, 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 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.

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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days 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: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SOUTHPORT ELEMENTARY	FACILITY NUMBER: 574500901
	VISIT DATE: 07/06/2023

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Director was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 of Early Childhood Education, Rahele Atabaki.

The following items are required before a license will be issued:
1. Remaining documents listed on LIC184
2. Licensing Program Manager (LPM) final file review
3. Granted Fire Clearance (STD850)

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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