<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 054500739
Report Date: 12/07/2022
Date Signed: 12/07/2022 12:30:05 PM

Document Has Been Signed on 12/07/2022 12:30 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:SARAH KELLY'S CHILD CARE & LEARNING CENTERFACILITY NUMBER:
054500739
ADMINISTRATOR:SARAH KELLYFACILITY TYPE:
840
ADDRESS:4423 SIX MILE ROADTELEPHONE:
(209) 263-2295
CITY:ANGELS CAMPSTATE: CAZIP CODE:
95222
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 0DATE:
12/07/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Sarah KellyTIME COMPLETED:
12:45 PM
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 and Licensing Program Analyst (LPA) Tiffanie Diep met with Applicant, Sarah Kelly for the purpose of an announced pre-licensing inspection. Applicant requests a school-age license to serve 28 school-age children from kindergarten and above. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The facility will be providing afternoon snack during the school year and breakfast, lunch, and snacks during holidays and summer.

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.

INDOOR ACTIVITY SPACE:
There is one school-age classroom/multipurpose room. AS observed a sufficient amount of equipment, tables, and chairs. The first aid kit and medication will be located in the sick room. 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 pitcher in the classroom. AS observed a functional carbon monoxide detector in the classroom. AS observed a sign-in/sign-out binder.

AS measured one classroom. The total classroom space contains a total of 580 square feet, which will only accommodate 16 school-age children. There is 1 toilet and 1 sink for the children so AS informed applicant that they can only accommodate 15 school-age children. There is a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the sick room 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: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: SARAH KELLY'S CHILD CARE & LEARNING CENTER
FACILITY NUMBER: 054500739
VISIT DATE: 12/07/2022
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
26
27
28
29
30
31
32
OUTDOOR ACTIVITY SPACE:
There is one school-age outdoor area on the property that is shared with the preschool children. Applicant has requested a shared outdoor space waiver. The outdoor play area is fenced with a wire fence that is at least four feet tall. AS observed a sufficient amount of equipment and toys. Applicant has provided AS with play structure equipment safety label for the slides and climbing wall which is designated for ages three year and above. There are shaded areas supplied by trees. AS observed a season creek that is fully surrounded by a five foot fence. Applicant stated that children do not have access to the creek.

AS measured the outdoor activity space. The outdoor play area contains a total of 7,254 square feet, which will accommodate 16 school-age 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)/ (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: supervision; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS 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, 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: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: SARAH KELLY'S CHILD CARE & LEARNING CENTER
FACILITY NUMBER: 054500739
VISIT DATE: 12/07/2022
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
26
27
28
29
30
31
32
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, Sarah Kelly.

The following items are required before a license will be issued:
1. Granted fire clearance (STD850)
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3