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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623888
Report Date: 04/20/2021
Date Signed: 04/21/2021 09:35:13 AM

Document Has Been Signed on 04/21/2021 09:35 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:KIDS' PLACE, THEFACILITY NUMBER:
313623888
ADMINISTRATOR:BROWN, MARIAHFACILITY TYPE:
830
ADDRESS:1115 COMBIE RDTELEPHONE:
(530) 878-7875
CITY:MEADOW VISTASTATE: CAZIP CODE:
95722
CAPACITY: 10TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/20/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jessica GarofaloTIME COMPLETED:
12:30 PM
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Application Specialist (AS) Seychelle De Luca and Licensing Program Analyst (LPA) Alize Tillery met with Applicant Jessica Garofalo for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Applicant requests an infant license to serve 10 infant children from birth to age two years. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 3/25/2021.

Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, Effects of Lead Exposure brochure, menus, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. The facility will provide morning and afternoon snacks for older infants. Parents will provide lunch for older infants and all food for younger infants.

INDOOR ACTIVITY SPACE:
There is one infant classroom. AS and LPA observed a sufficient amount of equipment, toys, and cubbies. AS and LPA observed three cribs in the crib room. The crib room is next to the infant classroom. There is a first aid kit in preschool classroom. AS and LPA observed cleaning disinfectants and medications are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated the children also have their own sippy cups and the facility will have extras. AS and LPA observed a functional carbon monoxide detector in the crib area. Applicant stated the facility will use a paper sign-in/sign-out system.

Report continues on 809-C.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Seychelle De Luca
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2021
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: KIDS' PLACE, THE
FACILITY NUMBER: 313623888
VISIT DATE: 04/20/2021
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Applicant measured the classrooms; and AS walked her through the measuring process. The total classroom space contains a total of 199.83 square feet, which does not accommodate Applicant's request for 10 infant children. The space allows for a maximum of five infants. AS and LPA observed a pull down changing table in the bathroom that is within arm's reach of the sink; however, the facility needs a changing pad that is at least one inch thick with raised sides that are at least three inches tall. There is one toilet and one sink for the children, and 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 office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:


There is one outdoor play area for infant children. The play space is surrounded by a chain link fence that is at least four feet tall. The play space will be shared by preschool and infant children; Applicant already submitted a shared outdoor space waiver request. AS and LPA did not observe a sufficient amount of equipment and toys. There is a shaded area supplied by a pop-up tent. There is a climbing structure that Applicant stated it anchored into the ground. Applicant acknowledges staff must ensure children use age-appropriate equipment at all times.

Applicant measured the outdoor space; and AS walked her through the measuring process. The outdoor play area contains a total of 1990.86 square feet, which accommodates Applicant's request for 10 infant children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the preschool file. 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 continues on 809-C.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Seychelle De Luca
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
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: KIDS' PLACE, THE
FACILITY NUMBER: 313623888
VISIT DATE: 04/20/2021
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AS discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; criminal record clearances, 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 directors or an employee acting in the director's absence must be reported to department within 10 working days.

This facility evaluation report was reviewed and discussed with Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

This facility evaluation report was reviewed and discussed with Applicant. AS emailed a copy of the 809 to Applicant. Applicant understands she must reply that she received, read, and understands the report. AS provided LIC311A, safe sleep website and brochures, Effects of Lead Exposure brochure, and immunization card.



CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. A final review of the file by Licensing Program Manager (LPM) Keven Peters.
2. Applicant mail in an updated Application (LIC 200A) for 5 infant children.
3. AS receives updated fire clearance request for 5 infant children.
4. Proof a changing pad has been ordered.
5. Proof of one potty training chair.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Seychelle De Luca
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
LIC809 (FAS) - (06/04)
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