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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093624390
Report Date: 09/22/2022
Date Signed: 09/22/2022 11:34:44 AM

Document Has Been Signed on 09/22/2022 11:34 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:PLEASANT VALLEY PLAY GARDEN LLCFACILITY NUMBER:
093624390
ADMINISTRATOR:MCCLINTOCK, NICOLEFACILITY TYPE:
850
ADDRESS:4520 PLEASANT VALLEY ROADTELEPHONE:
(916) 768-5829
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
09/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicole McClintockTIME COMPLETED:
11:50 AM
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Licensing Program Analysts (LPAs) Arianna Manabat, Solei Marx, and Licensing Program Manager (LPM) Natalie Dunaway met with Applicant Nicole McClintock for the purpose of an announced pre-licensing inspection. Applicant request a preschool license to serve 24 preschool children from age two to entry into first grade. The program will operate as a drop-in, short-term, weekly program. Facility is open Monday through Friday with the morning component operating from 9:00 AM to 12:00 PM and the afternoon component operating from 12:30 PM to 3:30PM. The program will provide a full-day option for a limited number of children. The fire clearance was granted on August 30th, 2022 for 24 children. Licensee was reminded to never exceed capacity for indoor area.

LPAs and LPM 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. 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.

Applicant stated the facility will provide AM and PM snack. Lunches are brought from home.

INDOOR ACTIVITY SPACE:
There are two classrooms within the facility. LPAs and LPM observed sufficient amount of age-appropriate equipment, toys, tables, and cubbies. There is a first aid kit in the classroom. Applicant stated that they will not provide medication services. Applicant stated there are no firearms or weapons on the premises. Applicant stated indoor and outdoor drinking water will be provided via water bottles and water cups. The facility is utilizing bottled water for drinking and cooking water. LPAs and LPM observed carbon monoxide detectors throughout the facility. LPA and LPM observed a sign-in/sign-out sheet within the facility’s Bright Wheel Application. Sign in Sign out is done electronically.
(Report continued on subsequent LIC 809)
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: PLEASANT VALLEY PLAY GARDEN LLC
FACILITY NUMBER: 093624390
VISIT DATE: 09/22/2022
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LPAs and LPM measured both classrooms. The total classroom space contains a total of 893.46 square feet, which will accommodate the requested capacity for 24 preschool children. There are two toilets and two sinks available for children to use in the facility. There is a separate private restroom for the staff.

Children who become ill during the day will be isolated in the loft area and the staff restroom. Individual measurements are recorded on the Capacity Worksheet (LIC 9024) that will be kept on file at the regional office.
OUTDOOR ACTIVITY SPACE:
There is one outdoor activity space for preschool children. The outdoor play area is surrounded by a fence that is at least four feet tall. LPAs and LPM observed trees and umbrellas utilized for overhead shade structure. The playground contains bark and mixed substrates that are used for cushioning. LPAs and LPM observed sufficient amount of age appropriate equipment and toys. Applicant was reminded that children are to use age appropriate toys and equipment.

LPAs and LPM measured the outdoor space. The outdoor play area contains a total of 8008.81 square feet, which will accommodate Applicant's request for 24 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

LPAs and LPM 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. LPAs and LPM discussed with the Applicant that 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

(Report continued on subsequent LIC 809)

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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: PLEASANT VALLEY PLAY GARDEN LLC
FACILITY NUMBER: 093624390
VISIT DATE: 09/22/2022
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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.

All Child Care Centers (CCCs) that are located in buildings constructed before January 1, 2010 must have their drinking water tested for lead and post the results by January 1, 2023 and every 5 years after the date of the initial test. For a license issued on or after July 1, 2022, the CCC must have its water tested and post the results within 180 days of licensure.

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.

Prior to licensure the following must be completed;

1. Revised Admission Agreement

2. Personnel Policies: Revision to add DOJ, CACI, and FBI clearances.

3. Provide proof of a sufficient amount of cots/ mats which meet regulations for children who remain for full-day options.

LPA Manabat will issue a license to facility Licensee pending amended documents and Licensing Program Manager’s final review.

Upon receipt of the above, the center will be licensed for 24 children.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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