343624646-2-14-2023-03-CC-MLOR-CP2T7M-20230214132859

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624646
Report Date: 02/14/2023
Date Signed: 02/14/2023 01:29:05 PM

Document Has Been Signed on 02/14/2023 01:29 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:	CREEKSIDE PRESCHOOL & INFANT CENTER		FACILITY NUMBER:	343624646
ADMINISTRATOR:	TBD		FACILITY TYPE:	840
ADDRESS:	2550 BELPORT LANE		TELEPHONE:	(916) 276-0279
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	02/14/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ginette Stephens, Roberta Manley		TIME COMPLETED:	01:45 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) Mai Lor and Licensing Program Analyst (LPA) Karyn Guerra met with Applicant Ginette Stephens for the purpose of an announced pre-licensing inspection. Present during this inspection are site director Roberta Manley and Christina Diaz Bushman. Applicant is requesting a school-age license to serve 10 school-age children enrolled in kindergarten and above. The program will operate Monday through Friday from 6:00 AM to 6:00 PM. The fire clearance was granted on 02/06/2023 with the following condition: upstairs not approved for daycare. AS 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/PM snack, and a lunch. INDOOR ACTIVITY SPACE: There are two school-age classrooms. AS and LPA observed sufficient amount of equipment, toys, tables, and storage space. There is a first aid kit in each classroom. Applicant stated medications will stored in the office and inaccessible to children. Applicant stated there are no firearms or weapon on the premises. Applicant stated indoor and outdoor drinking water will be provided to children by Brita water filter and water bottles. AS observed carbon monoxide detectors throughout the facility. AS and LPA observed a paper sign in and sign out system. Applicant stated the facility will provide breakfast, lunch and morning and afternoon snacks. (Report continued on subsequent LIC 809)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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: CREEKSIDE PRESCHOOL & INFANT CENTER	FACILITY NUMBER: 343624646
	VISIT DATE: 02/14/2023

NARRATIVE

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AS and LPA measured the classroom spaces. The total classroom space contains a total of 670.54 square feet, which will accommodate the requested capacity for 10 school-age children. There is one toilet and one sink available for school age children use. There is a separate private restroom for the staff. Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There is an outdoor activity space for preschool children. The applicant submitted a shared space outdoor waiver for the school-age children to share with the preschool children. A schedule was submitted with the waiver. The applicant was reminded to use age-appropriate equipment and toys. The outdoor play area is surrounded by a wood and chain linked fence that is at least four feet tall. However, some parts of the fence needs to be fixed to close the fencing gap. AS and LPA observed a swing set that is anchored to the ground. AS and LPA observed sufficient bark used under swing. Applicant stated the playground will be modified in the future to fit the needs of the center. Applicant was reminded to inform the department prior to construction or alteration. The outdoor space is shaded by trees and overhangs.

AS and LPA measured the outdoor space. The outdoor play area contains a total of 8,333.24 square feet, which will accommodate Applicant's request for 10 school-age children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

AS 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. 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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.

(Report continued on subsequent LIC 809)

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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: CREEKSIDE PRESCHOOL & INFANT CENTER	FACILITY NUMBER: 343624646
	VISIT DATE: 02/14/2023

NARRATIVE

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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.

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.

Applicant stated the upstairs building will be rented out in the future. Applicant was reminded that all future tenants residing in the upstairs building will require a criminal record clearance per Health and Safety Code 1596.871(b)(1).

The following items must be submitted prior to issuing a license:

1. Updated fire clearance

2. updated LIC 200A

3. photo of the corrected fence

Exit interview conducted and report was reviewed with the Applicant, Ginette Stephens.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

LIC809 (FAS) - (06/04)

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