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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 034501168
Report Date: 07/25/2024
Date Signed: 07/25/2024 12:25:25 PM

Document Has Been Signed on 07/25/2024 12:25 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:AMADOR CHRISTIAN PLAYSCHOOLFACILITY NUMBER:
034501168
ADMINISTRATOR/
DIRECTOR:		KATIE FERNERFACILITY TYPE:
860
ADDRESS:8040 S.HWY.49TELEPHONE:
(209) 256-9073
CITY:JACKSONSTATE: CAZIP CODE:
95642
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 0DATE:
07/25/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Katie FernerTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Applicant/Director Katie Ferner for the purpose of a pre-licensing inspection. Applicant requests an infant component for 16 infants ages 0-24 months, a toddler component for 12 toddlers ages 18-36 months, and a preschool component for 22 preschool children ages two years to entry into kindergarten for a total capacity of 50. The program will operate Monday through Friday from 7:30 a.m. to 5:30 p.m. The fire clearance was granted and received on 7/24/2024. The facility will be providing breakfast, lunch, and snacks. Parents will provide formula, breast milk, and baby food for their children.

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed the safe sleep regulations with applicant 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. LPA also informed applicant 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 are two infant classrooms located in rooms #1 and #2, one toddler classroom located in room #3, and two preschool classrooms located in rooms #4 and #6. The office is in room #5. LPA observed a sufficient amount of equipment, toys, tables, chairs, high chairs, cubbies, and napping cots for the children. LPA observed a crib area in room #1 with five cribs.

Report continues on LIC809-C page 2.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: AMADOR CHRISTIAN PLAYSCHOOL
FACILITY NUMBER: 034501168
VISIT DATE: 07/25/2024
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Page 2.

The crib area is separated from the activity space by a four-foot-tall wall partition. There is a first aid kit in each of the classrooms and yards. Medications will be stored in a locked box in the office of in a certain classroom depending on where the child is placed. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated there are jugs outside and water pitchers in all classrooms. LPA observed a functional carbon monoxide detector in the office. Applicant stated that the building also has dual smoke and carbon monoxide detectors. LPA observed an electronic sign-in/sign-out system.

LPA measured the infant classrooms #1 and #2. The infant classroom spaces contain a total of 734 square feet, which will accommodate applicant's request for 16 infants. LPA measured the toddler classroom #3. The toddler classroom space contains a total of 441 square feet, which will accommodate applicant’s request for 12 toddlers. LPA measured the preschool classrooms #4 and #6. The preschool classroom spaces contain a total of 818 square feet, which will accommodate applicant’s request for 22 preschool children. Applicant stated that there is an additional room for indoor play activities located in the Hall Room. There is one toilet and three sinks located in and in between rooms #1 and #2. LPA observed a changing table within arm’s reach of a sink. Applicant stated that the toddlers and preschool children will utilize the men's restroom located down the hall from room #6. LPA reminded applicant that men's restroom must be designated for the children during the hours of operation. LPA observed four toilets, five urinals, and three sinks for the children. There is a separate private restroom for the staff located down the hall in the women's restroom. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office (room #5) and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There are two outdoor areas on the property, Infant/Toddler Yard and Preschool Yard. Applicant has requested a Shared Outdoor Space Waiver for the infants and toddlers. The outdoor play areas are fenced with a chain link fence that is at least four feet tall and separates the infant/toddler yard from the preschool yard. There is one play structure located on the preschool yard which includes a safety label designated use for children 2 to 5 years old. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees, building overhang, and a large canopy.

Report continues on LIC809-C page 3.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: AMADOR CHRISTIAN PLAYSCHOOL
FACILITY NUMBER: 034501168
VISIT DATE: 07/25/2024
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LPA measured the Infant/Toddler Yard. The outdoor infant/toddler area contains a total of 1,814 square feet, which will accommodate applicant's request for 16 infants and 12 toddlers. LPA measured the Preschool Yard. The outdoor preschool area contains a total of 2,702 square feet, which will accommodate applicant’s request for 22 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

LPA 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. LPA 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.

Applicant 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.

Applicant 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.

Report continues on LIC809-C page 4.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: AMADOR CHRISTIAN PLAYSCHOOL
FACILITY NUMBER: 034501168
VISIT DATE: 07/25/2024
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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 Applicant/Director Katie Ferner.

The following items are required before a license will be issued:
1. Pending approval of Shared Outdoor Space Waiver.
2. Photo of infant changing tables with three inches high raised side.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4