343624918-9-8-2023-03-CC-JGAG-CVGRQL-20230908131342

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343624918
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:13:49 PM

Document Has Been Signed on 09/08/2023 01:13 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:	343624918
ADMINISTRATOR:	CHRISTINA DIAZ BUSHMAN		FACILITY TYPE:	840
ADDRESS:	2433 MISSION AVENUE		TELEPHONE:	(916) 276-0279
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY: 18	TOTAL ENROLLED CHILDREN: 18	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 18 school age children. 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, and daily schedule. Applicant Specialists discussed the forms that must be in each child's and each staff member's file. The facility will provide breakfast, lunch, and morning and afternoon snacks. INDOOR ACTIVITY SPACE: There is one school-age space. LPA and LPM observed a sufficient amount of tables, chairs, equipment, and toys. Applicant stated cleaning disinfectants and medications will be appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated the facility will have a water pitcher and parents will provide water containers from. Per Applicant, the carbon monoxide detector is wired into the fire alarm system. LPA and LPM observed trash cans with lids. LPA and LPM observed a sign in and out sheet near 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: 343624918
	VISIT DATE: 09/08/2023

NARRATIVE

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LPA and LPM measured the classroom. The classroom space contains a total of 713.617 square feet, which accommodates Applicant's request for 18 children. There are two toilets and two sinks for the children. There is 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 use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There are two outdoor spaces on the property for school-age children; the courtyard (shared between preschool and school age) and the school age yard. LPA and LPM measured the outdoor space. The outdoor play area contains a total of 3,652.072 square feet, which accommodates Applicant's request for 18 children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Applicant acknowledges children must use age appropriate equipment. The outdoor play areas is barricaded with a metal fence that is at least four feet tall. 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 trees and structures.

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: 343624918
	VISIT DATE: 09/08/2023

NARRATIVE

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LPA 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. LPA 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 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 understand he must read the reports and send back an acknowledgement that he read and received the report. LPA also provided LIC311A and Effects of Lead Exposure brochure.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. A final review of the file by Licensing Program Manager (LPM) Seychelle De Luca.

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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