093624585-2-3-2023-03-CC-MLOR-CNPQJR-20230203111311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 093624585
Report Date: 02/03/2023
Date Signed: 02/03/2023 11:13:40 AM

Document Has Been Signed on 02/03/2023 11:13 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:	JOHN ADAMS ACADEMY		FACILITY NUMBER:	093624585
ADMINISTRATOR:	ERICKSON, CHRISTA		FACILITY TYPE:	840
ADDRESS:	1104 INVESTMENT BLVD		TELEPHONE:	(916) 260-3251
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS:	DATE:	02/03/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Shelly Duncan, Amara Baylor-Holloway, Christa Erickson		TIME COMPLETED:	11:30 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	Application Specialist (AS) Mai Lor and Licensing Program Analyst (LPA) Soleil Marx met with Applicant Shelly Duncan, Facility Director Christa Erickson, and Site Director Amara Holloway-Baylor for the purpose of an announced pre-licensing inspection. Applicant is requesting a school-age license to serve 120 school-age children enrolled in kindergarten and above. The facility is located on the John Adams Academy El Dorado Hills campus. The facility will be utilizing Classroom #5, Auditorium and Cafeteria. The fire clearance was granted on 01/17/2023. Per fire clearance, Classroom #5 is approved for a maximum capacity of 41 persons and the cafeteria is approved for a maximum capacity of 230 persons. The auditorium is under construction and will not be utilized. AS advised the applicant to inform licensing when the auditorium is ready to be licensed. The facility hour of operation is Monday through Friday from 6:30am to 6:00pm. The program offers before and after school care. Before care will operate Monday through Friday from 6:30am to 8:00am and after care will operate Monday through Thursday from 2:50pm to 6:00pm and on Friday from 11:50am to 6:00pm. Classroom #5 will be utilized for full day program while the cafeteria will utilized for before and after care, and during camp days. The facility has requested for a waiver to have one director manage and shall be responsible for the operation of two licensed childcare centers (#093624585 and #093622537), for compliance with regulations, and for communications with the Department; and has the authority to acknowledge receipt of deficiency notices and to correct deficiencies that constitute immediate threats to children's health and safety. The facility also requested for a waiver for all employee clearances to be associated to Champions @ John Adams #313621215. AS granted the above waiver requests and the Licensee Representative understands the waiver must be posted at all times and the conditions of the waiver must be met. (Report continues on subsequent LIC 809)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: JOHN ADAMS ACADEMY	FACILITY NUMBER: 093624585
	VISIT DATE: 02/03/2023

NARRATIVE

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The applicant stated the facility will not provide childcare services until the following school year (August 2023) and will not be utilizing this location for the remainder of the school year.

AS reviewed with applicant the LIC 311A; records to be maintained at the facility to include child’s records, personnel records, and administrative records; and documents to be posted. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule. The facility will provide morning and afternoon snacks, and children will bring their own lunch.

INDOOR ACTIVITY SPACE:
AS and LPA inspected Classroom #5 and Cafeteria. AS observed sufficient number of child size tables, chairs, and backpack racks. AS and LPA observed a variety of age-appropriate toys and equipment. There is a first aid kit the classroom and the cafeteria. Applicant stated medications and cleaning disinfectants will be stored in the classroom and cafeteria in a locked cabinet and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. AS observed a functional carbon monoxide detector in the classroom. Applicant stated they will be utilizing a paper sign in/out system. Applicant stated water will be provide via tap water. The facility has water fountains located throughout the school campus, which will be accessible to children in care. Facility will be utilizing the school's nurse station for isolation and use the staff restroom if necessary.

Per Health and Safety Code1596.806 Exemption from square footage, toilet, isolation space, outdoor activity space, and fencing requirements, AS did not measure the indoor and outdoor activity space.

Per the Applicant, the facility will utilize the outdoor activity space and the school’s restrooms. Facility submitted a certification statement signed by the Executive Director of John Adams Academy El Dorado Hills that the classroom building is of sufficient size to accommodate public instruction

OUTDOOR ACTIVITY SPACE:
The facility will use John Adams Academy El Dorado Hills school campus outdoor play area; however, the outdoor activity space is under construction. A part of the school parking lot will be utilized as the outdoor activity space. The applicant stated the school will be moving the play structure from the active licensed center and installing it at this location.
(Report continues on 809-C.)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: JOHN ADAMS ACADEMY	FACILITY NUMBER: 093624585
	VISIT DATE: 02/03/2023

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Applicant stated the outdoor space will be constructed in similar fashion as the actively licensed center. Applicant stated play equipment will be brought over from the active licensed center.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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.

Applicant 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.

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

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.

This application requires further review by the Department.

Exit interview conducted and report was reviewed with Applicant, Shelly Duncan, Facility Director Christa Erickson, and Site Director Amara Holloway-Baylor.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC809 (FAS) - (06/04)

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