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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624916
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:11:31 PM

Document Has Been Signed on 09/08/2023 01:11 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MISSION AVENUE PRESCHOOLFACILITY NUMBER:
343624916
ADMINISTRATOR:CHRISTINA DIAZ BUSHMANFACILITY TYPE:
830
ADDRESS:2433 MISSION AVENUETELEPHONE:
(916) 276-0279
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
09/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Ginette MaruriTIME COMPLETED:
01:25 PM
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On September 8, 2023 at approximately 9:00 AM Licensing Program Analyst (LPA) Josiah Gathing and Licensing Program Manager (LPM) Seychelle De Luca met with Applicant Ginette Maruri for the purpose of an announced change of ownership prelicensing inspection. Applicant requests an infant license to serve 22 children from age 0 to 2 years. The program will operate Monday through Friday from 6:00 AM to 6:00 PM.

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. LPM discussed the forms that must be in each child's file and each staff member's file. The facility will provide breakfast, lunch, and afternoon snacks. Parents will provide formula and infant food.

INDOOR ACTIVITY SPACE:
There are four infant classrooms. All of these spaces are located in the front building. LPA and LPM observed a sufficient amount of equipment, toys, and tables. There were 10 cribs in the napping area. There are first aid kit supplies, a fully charged fire extinguisher, and trash cans with lids. Applicant stated medications will be stored in the kitchen. Applicant stated there are no poisons or firearms on the premises. There is a functional carbon monoxide detector in the younger infant classroom. LPA observed daily sign in and sign out binders.

LPA and LPM measured the infant classrooms. The infant classroom space contains a total of 671.009 square feet, which does not accommodate Applicant's request for 22 infants. The available square footage allows for a maximum of 19 infants. There are four sinks for the infants and two changing tables within arm’s length of a sink. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).


Report continues on 809-C…
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MISSION AVENUE PRESCHOOL
FACILITY NUMBER: 343624916
VISIT DATE: 09/08/2023
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OUTDOOR ACTIVITY SPACE:
There is one outdoor area for infants on the property shared between infants and toddlers in the toddler option (Infant/Toddler Yard 1). A section of the fence surrounding the outdoor play area is under four feet. The outdoor space is separated from the preschool and school-age play yards with fences. LPA and LPM discussed the requirement to fully enclose the area with fencing over four feet. LPA and LPM observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by structures and trees. Applicant acknowledges staff must ensure children use age-appropriate equipment at all times.

LPA and LPM measured the outdoor space. The outdoor play area contains a total of 2,109.912 square feet, which accommodates Applicant's request for 22 infants. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the facility 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.

LPA discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MISSION AVENUE PRESCHOOL
FACILITY NUMBER: 343624916
VISIT DATE: 09/08/2023
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LPA 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. LPA discussed with Director 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.

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. LPA provided LIC311A.



CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:

1. A final review of the file by Licensing Program Manager (LPM) Seychelle De Luca.
2. Updated fire clearance for 19 infant children.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC809 (FAS) - (06/04)
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