554500962-11-29-2023-53-CC-ASIS-CY34Z7-20231129183216

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 554500962
Report Date: 11/29/2023
Date Signed: 11/29/2023 06:32:21 PM

Document Has Been Signed on 11/29/2023 06:32 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	KOUNTRY KIDS PRESCHOOL		FACILITY NUMBER:	554500962
ADMINISTRATOR:	ECROYD, DENISE		FACILITY TYPE:	830
ADDRESS:	229 SOUTH SHEPHERD STREET		TELEPHONE:	(209) 533-1500
CITY:	SONORA	STATE: CA	ZIP CODE:	95370
CAPACITY: 4	TOTAL ENROLLED CHILDREN: 4	CENSUS: 0	DATE:	11/29/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Denise Ecroyd		TIME COMPLETED:	03:00 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	Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Licensee, Denise Ecroyd for the purpose of a pre-licensing inspection. Licensee currently has a preschool license and is requesting an infant license to serve 4 infant children from 0-24 months. The program will operate Monday through Friday from 7:30 a.m. to 5:30 p.m. The fire clearance was granted and received on 11/21/2023. Parents will provide all meals including formula, breast milk, and baby food for their children. LPA reviewed with Licensee the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA discussed the safe sleep regulations with Licensee 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 Licensee 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. INDOOR ACTIVITY SPACE: There is one infant classroom. LPA observed a sufficient amount of equipment, toys, chairs, and cubbies. LPA observed a crib area, however the area was not separated with a four-foot-tall wall partition. LPA observed two cribs and extra cribs available if needed. Licensee will submit a photo of the completed crib partition. There is a first aid kit in each of the kitchen. Medications will be stored in the kitchen in a lock box and refrigerator. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Licensee stated there are no poisons or firearms on the premises. Report continues on LIC809-C.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KOUNTRY KIDS PRESCHOOL	FACILITY NUMBER: 554500962
	VISIT DATE: 11/29/2023

NARRATIVE

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LPA observed a functional carbon monoxide detector in the kitchen. LPA observed a sign-in/sign-out system binder.

LPA measured the infant classroom activity space. The total classroom space contains a total of 143 square feet, which will accommodate Licensee’s request for 4 infant children. There is a separate private restroom for the staff located down the hall between two classrooms. LPA 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 changing room and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor area will be shared with the preschool program. Licensee has requested a Shared Outdoor Space Waiver. The outdoor play area is fenced with a wrought iron fence and a wooden fence that is at least four feet tall. There is no permanent play structure. LPA 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 a shaded deck area. LPA observed a portion of the playground under construction and blocked off with temporary orange safety fencing. Licensee received a grant and is installing pour-n-play, science and garden center, bike area, and patio. Licensee stated play area completion date was expected for September and is now anticipated schedule for January 2024. LPA observed the right portion of the playground is available for use for the children.

LPA used current measurements from preschool report dated 6/8/2009 (550321246). The outdoor play area contains a total of 5,565 square feet, which will accommodate Licensee's request for 4 infant 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) or (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 LIC809-C.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KOUNTRY KIDS PRESCHOOL	FACILITY NUMBER: 554500962
	VISIT DATE: 11/29/2023

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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 Licensee 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.

Licensee 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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, Denise Ecroyd.

The following items are required before a license will be issued:
1. Photo of crib area wall partition.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

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