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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500636
Report Date: 08/01/2022
Date Signed: 08/01/2022 03:06:12 PM

Document Has Been Signed on 08/01/2022 03:06 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:FOULKS RANCH ELEMENTARY SCHOOLFACILITY NUMBER:
344500636
ADMINISTRATOR:THOMPSON, TABITHAFACILITY TYPE:
850
ADDRESS:6211 LAGUNA PARK DRTELEPHONE:
(916) 684-8177
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Tabitha ThompsonTIME COMPLETED:
01:15 PM
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Application Specialist (AS) Alecia Sifuentes met with Licensee Representative, Tabitha Thompson for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 24 preschool children from age two to entry into kindergarten. The program will operate Monday through Thursday from 8:00 a.m. to 11:30 a.m. The fire clearance was granted on 6/30/2022. The facility will provide breakfast and snack.

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.

INDOOR ACTIVITY SPACE:
There is one preschool classroom. AS observed a sufficient amount of equipment, toys, tables, chairs, and cubbies. There is a first aid kit in the classroom cabinet and on the play yard. Medications will be stored in the classroom cabinet. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. AS observed water fountain in the classroom. AS observed a dual functional smoke and carbon monoxide detector. AS observed an electronic sign-in/sign-out system.

AS measured one classroom. The total classroom space contains a total of 1,184 square feet, which will accommodate Applicant's request for 24 preschool children. There are 2 toilets and 2 sinks for the children, and a separate private restroom for the staff. The second toilet is located in the next door elementary school classroom. AS will provide Licensee Representative with a Shared Bathroom Waiver. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

Report continue on LIC809-C
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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: FOULKS RANCH ELEMENTARY SCHOOL
FACILITY NUMBER: 344500636
VISIT DATE: 08/01/2022
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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall. Licensee Representative stated that the elementary school children in the next door classroom will also be utilizing the yard. Licensee Representative has requested a Shared Outdoor Space Waiver. AS observed a sufficient amount of equipment and toys. The play structure includes a safety label, which designates use for children 5 and above. AS informed Licensee Representative that the children cannot play on the play structure. Licensee Representative understood and stated that they will look into installing a second play structure for children 2-5 years old. There are no bodies of water on the premises. There are shaded areas supplied by trees, canopy, and overhangs.

AS measured the outdoor activity space. The outdoor play area contains a total of 11,913 square feet, which will accommodate Applicant's request for 24 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

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

AS discussed the following: 100% supervision is required at all times, including in the bathroom; 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.
Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 continue on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
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: FOULKS RANCH ELEMENTARY SCHOOL
FACILITY NUMBER: 344500636
VISIT DATE: 08/01/2022
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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.

Exit interview conducted and report was reviewed with the Licensee Representative, Tabitha Thompson.

The following items are required before a license will be issued:
1. Remaining Principal documents.
2. Final file review from Licensing Program Manager (LPM).
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
LIC809 (FAS) - (06/04)
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