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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500627
Report Date: 07/21/2022
Date Signed: 07/21/2022 10:30:59 AM

Document Has Been Signed on 07/21/2022 10:30 AM - 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:HENS & CHICKS EARLY LEARNINGFACILITY NUMBER:
574500627
ADMINISTRATOR:WAGGONER, KARINFACILITY TYPE:
850
ADDRESS:1500 PARK BLVDTELEPHONE:
9164708505
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 20TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karin Waggoner & Beatriz PerezTIME COMPLETED:
11:00 AM
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Application Specialist (AS) Alecia Sifuentes met with Applicant, Beatriz Perez and Licensee Representative/Director, Karin Waggoner for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 20 preschool children from age two to entry into kindergarten. The program will operate Monday through Friday from 8:00 a.m. to 5:00 p.m. The fire clearance was granted and received on 6/1/2022. The facility will provide morning afternoon snacks.

AS reviewed with Director 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, cubbies, and napping cots. There is a first aid kit in each of the classrooms. Medications will be stored in the classroom cabinet in a locked box. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Applicant stated parents will provide water bottles that will be refilled using the classroom water fountain/sink. AS observed a functional dual smoke and carbon monoxide detector in the classroom. AS observed a sign-in/out binder.

AS measured one classroom. The total classroom space contains a total of 772.19 square feet, which will accommodate Applicant's request for 20 preschool children. Applicant stated that they would like to request the max capacity of 22 preschool children. There are 2 toilets and 3 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 hallway area and will use the staff restroom, if necessary.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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: HENS & CHICKS EARLY LEARNING
FACILITY NUMBER: 574500627
VISIT DATE: 07/21/2022
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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. There is a small parking lot located within the playground. Applicant stated it is not in use and there is a second parking lot located for parents and staff on the right side/opposite side of the building. AS observed a sufficient amount of equipment and toys. AS observed a small play structure that did not include a safety label. Applicant stated that they will locate previous paperwork or contact the manufacturer regarding the age range. AS informed Applicant that the children cannot utilize the play structure until they submit the age range to the department. 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 27,871 square feet, which will accommodate Applicant's request for 22 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 Director 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.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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: HENS & CHICKS EARLY LEARNING
FACILITY NUMBER: 574500627
VISIT DATE: 07/21/2022
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Director 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.

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 Applicant, Beatriz Perez and Director, Karin Waggoner.

The following items are required before a license will be issued:
1. Updated granted fire clearance (STD850)
2. Final file review from Licensing Program Manager (LPM) Bettina Engelman
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC809 (FAS) - (06/04)
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