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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045408226
Report Date: 03/02/2023
Date Signed: 03/15/2023 11:55:59 AM

Document Has Been Signed on 03/15/2023 11:55 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:ACORNS TO OAKS PRESCHOOL AND DAYCARE LLCFACILITY NUMBER:
045408226
ADMINISTRATOR:SIVADON, SHANNONFACILITY TYPE:
830
ADDRESS:2448 TOM POLKTELEPHONE:
(530) 520-0251
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
03/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH: Erica Metzen and Shannon Sivadon. TIME COMPLETED:
12:40 PM
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A prelicensing inspection was conducted today at 10:30am by Licensing Program Analyst (LPA), Laura Chavez. LPA met with applicants Erica Metzen and Shannon Sivadon. The applicants are requesting a license for infants, with a capacity of 16. The facility will operate Monday-Friday, 7am to 6pm. The facility has one bathroom for staff use.

The indoor and outdoor activity spaces were toured, and the facility sketch was verified. The following areas will be off limits to children: janitorial/storage room and staff bathroom. These areas have been made inaccessible by means of locks. There is a kitchen area to store/prepare meals. There is a nap area for infants to sleep with 6 cribs and cots available. Applicants understand awake infants will not be allowed in the napping area while infants are sleeping. The isolation area for sick children will be located in the office located in the preschool building. The changing table is located within arm reach of a sink.

The outdoor play area is fully fenced and adequate cushioning underneath. A waiver request is requesting to allow infants to share the outdoor play area with preschool age children at different times. There is no pool, spa, pond, fountain, or any other body of water on the premises. There is safe and age appropriate furniture, toys, and play equipment available for children. A capacity worksheet was completed during the visit. There is enough indoor space for 18 children and outdoor space for 75 children. A second waiver request is requesting to allow the one bathroom in the infant building to be designated as the staff bathroom to be used between the preschool and infant staff. Based on the above, the maximum capacity of the facility could be 18.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: ACORNS TO OAKS PRESCHOOL AND DAYCARE LLC
FACILITY NUMBER: 045408226
VISIT DATE: 03/02/2023
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LPA reviewed with the applicants the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Applicants were 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.

LPA discussed the safe sleep regulations with applicant/licensee/facility representative and discussed the Child Care Licensing Safe Sleep webpage at:www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/
safe-sleep as an additional resource. LPA also informed applicant/licensee/facility representative 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.

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.
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SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: ACORNS TO OAKS PRESCHOOL AND DAYCARE LLC
FACILITY NUMBER: 045408226
VISIT DATE: 03/02/2023
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The following items need to be completed prior to the granting of license:

1. Proof of nails removed or nailed into the corner fence 4x4.
2. Proof of replacing the fence board missing from the back corner portion of the fence.
3. Manager review of the waiver request for infants to share the outdoor play area with
preschool age children.

Exit interview conducted and report was reviewed with the applicants Erica Metzen and Shannon Sivadon.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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