394500414-6-15-2021-53-CC-ASIS-C3ZUMT-20210615154251

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500414
Report Date: 06/15/2021
Date Signed: 06/15/2021 03:45:14 PM

Document Has Been Signed on 06/15/2021 03:45 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:	ACHIEVERS		FACILITY NUMBER:	394500414
ADMINISTRATOR:	DIVYA KOHLI		FACILITY TYPE:	830
ADDRESS:	4453 PRECISSI LANE		TELEPHONE:	(209) 956-5437
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY: 7	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	06/15/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Divya Kohli		TIME COMPLETED:	04:00 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) Alecia Sifuentes met with Applicant, Divya Kohli for the purpose of an announced pre-licensing change of ownership inspection. Applicant requests an infant license to serve 7 infant children from birth to two years of age. The program will operate Monday through Friday from 6:30 a.m. to 6:00 p.m. The fire clearance received and granted on 6/15/2021. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat poster, menus, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. Applicant stated the Needs and Services plans and Individual Infant Sleeping Plan will be kept in the classroom. The facility will be providing breakfast, lunch, and snacks. Facility is with the food program and offers formula. Parents will provide breast milk and baby food for their children. INDOOR ACTIVITY SPACE: There is one infant classroom. AS observed a sufficient amount of equipment, toys, tables, chairs, high chairs, cubbies, napping cots, and two cribs. Applicant acknowledges there will be a maximum of two infants under 12 months old, due to available cribs. There is a first aid kit in the lounge. Medications will be stored in the kitchen. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated there will be a water pitcher and cups available in the classroom. AS observed a functional carbon monoxide detector in the kitchen and bathroom. AS observed sign-in/sign-out binders. Report continues on 809-C.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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: ACHIEVERS	FACILITY NUMBER: 394500414
	VISIT DATE: 06/15/2021

NARRATIVE

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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 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.

AS will issue a provisional license that will expire in 90 days on 9/13/2021. Once the provisional is issued, the following items are remaining prior to expiration of the provisional license for final approval of license:

1. Final file review from Licensing Program Manager (LPM) Bettina Engelman.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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: ACHIEVERS	FACILITY NUMBER: 394500414
	VISIT DATE: 06/15/2021

NARRATIVE

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AS measured the classroom. The total classroom space contains a total of 284.87 square feet, which will accommodate Applicant's request for 7 infant children. AS observed a changing table within arm's reach of a sink. 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.

OUTDOOR ACTIVITY SPACE:
There is one infant outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall and separates the infant yard from the school-age and preschool yards. AS 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 overhangs.

AS measured the outdoor activity space. The outdoor play area contains a total of 1,484.75 square feet, which will accommodate Applicant's request for 7 infant children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Incidental Medical Services 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: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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