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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622428
Report Date: 09/17/2021
Date Signed: 11/05/2021 11:25:21 AM

Document Has Been Signed on 11/05/2021 11:25 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:VILLAGE PRESCHOOL CENTERFACILITY NUMBER:
343622428
ADMINISTRATOR:RAINEAR, TOMIKAFACILITY TYPE:
850
ADDRESS:6845 LARCHMONT DRIVETELEPHONE:
(916) 566-3485
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 3DATE:
09/17/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Tabitha ThompsonTIME COMPLETED:
02:20 PM
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This is an amended report to correct the classroom number.

Application Specialist (AS) Mai Lor and Licensing Program Analyst (LPA) Tanya Washington met with Licensee Tabitha Thompson for the purpose of an announced capacity change case management inspection. Licensee request to decrease the preschool capacity from 41 to 24 preschool children ages three to entry into Kindergarten. The facility operates on Village Elementary School in adjoining portable classrooms #1 and #2. Census included 3 children and 2 staff. The facility's hours of operation are Monday through Friday from 8:00 AM to 2:30 PM. AS received the fire clearance on 8/26/21.

AS and LPA conducted a health and safety inspection in all areas accessible to preschool children. Licensee request to remove portable classroom #1 from the preschool license. The facility will be utilizing classroom #2 for preschool children. AS and LPA measured classroom #2. The total classroom space contains a total of 868.5624 square feet, which will accommodate the requested capacity of 24 preschool children. There are 3 toilets and 5 sinks available to children, and a separate staff restroom is available. 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.

AS and LPA observed sufficient number of furniture, toys, mats, cubbies, and play equipment in the classrooms. AS and LPA observed a functional carbon monoxide detector. AS and LPA observed disinfectants and medications are inaccessible and appropriately stored. AS and LPA observed an electronic sign-in/sign-out system.

(Report continues on subsequent LIC809)
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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: VILLAGE PRESCHOOL CENTER
FACILITY NUMBER: 343622428
VISIT DATE: 09/17/2021
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There is one outdoor area on the property designated for preschool, infant and toddler children. The outdoor play area is fenced with a chained link fence that is four feet tall. AS and LPA observed a variety of age-appropriate outdoor toys and equipment. There is a play structure that is designated for children ages 2 to 5. Applicant was reminded to follow the safety label and staff will provide supervision to ensure children under the age of 2 will not be using the play structure. Applicant submitted a waiver request to utilize the outdoor space among the preschool, infant and toddler children. Applicant shall follow the rotated schedule previously submitted. AS and LPA observed poured-in-place rubber used as cushion. The playground is shaded by a shade structure.

AS and LPA used previous outdoor measure from report dated 7/13/18. The total outdoor space is 4916.804 square feet, which will accommodate Licensee's request for 24 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Prior to this inspection, AS emailed LIC311A, Effects of Lead Exposure brochure and Provider Notice Information (PIN) 21-21 (Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers per AB 2370), and immunization card. AS and LPA reviewed lead testing requirement and COVID-19 technical assistance with the applicant.

This facility plans to provide Incidental Medical Services - IMS. For IMS information, see Evaluator Manuel - Regulation Interpretations and Procedures for Child Care Centers Section 101173 and 101226. A 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.

Licensee 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.

(Report continues on subsequent page LIC 809)
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: VILLAGE PRESCHOOL CENTER
FACILITY NUMBER: 343622428
VISIT DATE: 09/17/2021
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Prior to issuing a license, the following items must be corrected:


1. Partitions to separate the preschool classroom from the infant classroom
2.. Director Verifications (preventative health and safety training, LIC 508 (page 2), mandated reporter training)
3. Licensing Program Manager's final review

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Tabitha Thompson.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3