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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614029
Report Date: 10/17/2022
Date Signed: 10/17/2022 12:50:18 PM

Document Has Been Signed on 10/17/2022 12:50 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SMALLVILLE PRESCHOOLFACILITY NUMBER:
343614029
ADMINISTRATOR:NULL SHANNONFACILITY TYPE:
850
ADDRESS:4706 ARDEN WAYTELEPHONE:
(916) 480-0632
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 14DATE:
10/17/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Shannon NullTIME COMPLETED:
01:00 PM
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At 9:50 a.m. on Monday, October 17th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Shannon Null, for the purpose of a case management, Licensee initiated inspection. LPA observed a census of 14 preschool children supervised by 4 staff. The facility requests to increase the capacity to 49 children. Previous request was made for 48 children.

INDOOR ACTIVITY SPACE:
The indoor classroom space was measured and documented on a capacity worksheet. The total indoor classroom space measures 1735.81 square feet and will accommodate the new requested capacity of 49 children. LPA inspected the room addition and observed adequate tables, chairs, and napping mats. LPA also observed age appropriate materials and equipment for children. There is a total of 4 toilets and 6 sinks for the facility.

OUTDOOR ACTIVITY SPACE:
The outdoor space was previously measured and has not changed. There is a shared outdoor space waiver on file as the outdoor space is shared with the infant program.

Licensee submitted an updated application to LPA during inspection to reflect new capacity request of 49 children, per measurements observed today.

No deficiencies were cited during today's inspection. This report was reviewed with the Licensee and an exit interview was conducted. A notice of site visit was provided and shall remain posted for a period of 30 days for parental review.

The following corrections are needed prior to capacity change approval:

An updated fire clearance shall be received reflecting the updated capacity request of 49 children.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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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