343624917-9-8-2023-03-CC-JGAG-CVGRPZ-20230908131246

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624917
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:12:52 PM

Document Has Been Signed on 09/08/2023 01:12 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 PRESCHOOL		FACILITY NUMBER:	343624917
ADMINISTRATOR:	CHRISTINA DIAZ BUSHMAN		FACILITY TYPE:	850
ADDRESS:	2433 MISSION AVENUE		TELEPHONE:	(916) 276-0279
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 50	CENSUS: 0	DATE:	09/08/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Ginette Maruri		TIME COMPLETED:	01:25 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	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 a preschool license to serve 50 children from age two to entry into first grade including a toddler option. 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. LPA discussed the forms that must be in each child's and each staff member's file. The facility will provide breakfast, lunch, and afternoon snacks. INDOOR ACTIVITY SPACE: There are five preschool spaces. LPA and LPM observed a sufficient amount of equipment, tables, chairs, cubbies, and cots. LPA and LPM advised applicant to procure more toys for the preschool area. There are first aid kit supplies and trash cans with lids. LPA and LPM observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated medications will be stored in the kitchen. Applicant stated there are no poisons or firearms on the premises. Per Applicant water will be provided via a water pitcher and water containers will be provided by parents. LPA and LPM observed a functional carbon monoxide detector in the large preschool classroom. Per Applicant, the carbon monoxide detector is wired into the fire alarm system in the far building. LPA and LPM observed sign in sheets at the entrance. 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: 343624917
	VISIT DATE: 09/08/2023

NARRATIVE

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LPA and LPM measured the classrooms. The total classroom space contains a total of 1,555.589 square feet, which does not accommodate Applicant's request for 50 preschool children. The available square footage allows for a maximum of 44 preschool children. There are four toilets and four sinks 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 are two outdoor areas on the property for preschool children. The outdoor play areas have a metal fence that is at four feet tall. The outdoor space is separated from the infant and school-age play yards with fences. 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 5,260.057 square feet, which accommodates Applicant's request for 50 preschool children. 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.

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

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: 343624917
	VISIT DATE: 09/08/2023

NARRATIVE

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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 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.

Applicant understands he must reply that he received, read, and understands the report. LPA provided LIC311A, 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) Seychelle De Luca.
2. Updated fire clearance for 44 preschool children.
3. Proof more toys have been set up.
4. Updated sketch with all spaces identified.

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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