343627888-5-12-2026-03-CC-JGAG-DTZQ9D-20260512115807

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343627888
Report Date: 05/12/2026
Date Signed: 05/12/2026 11:58:18 AM

Document Has Been Signed on 05/12/2026 11:58 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	SETA MIRASOL VILLAGE		FACILITY NUMBER:	343627888
ADMINISTRATOR/ DIRECTOR:	XAYAVONG, SAMANTHA		FACILITY TYPE:	860
ADDRESS:	475 PIPEVINE STREET		TELEPHONE:	(916) 616-3748
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95811
CAPACITY: 88	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/12/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Betsy Uda		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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On May 12, 2026 at approximately 9:30 AM, Licensing Program Analyst (LPA), Josiah Gathing met with Licensee Representative (LR) Betsy Uda for an announced Pre-Licensing inspection. Applicant is requesting a license for 41 Toddlers (ages 18 to 36 months) in Rooms 1 and 2; 44 Preschool children (ages 3 to 5 years) in Rooms 3 and 4. The total requested capacity will be 85. Applicant originally requested a total capacity of 88, but the toddler capacity was reduced due to limited outdoor activity space. Areas of the facility not included in indoor activity space include the Enrollment Staff Desk, Site Supervisor Office, Enrollment Office, Staff Lounge, Kitchen, Staff Restrooms, and Children's Restrooms. Hours of operation will be Monday through Friday, 8:00 AM to 5:00 PM.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed LR that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, LR stated that they will be stored in locked boxes located in each classroom, inaccessible to children. LPA observed a first aid kit in each classroom. There is an operational carbon monoxide detector on site located in the hallway. All required licensing documents were observed posted near the entrance. Children will be signed in and out via tablet in each classroom.

Rooms 1 through 4 are identical in size. LPA measured total indoor toddler activity space of 1,645.55 square feet, which is sufficient to accommodate the requested capacity of 41 Toddlers. LPA measured total indoor Preschool activity space of 1,645.55 square feet, which is sufficient to accommodate the requested capacity of 44 Preschool Children. LPA observed all indoor activity space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, cots, bookshelves, and other activity supplies for the children.
Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: SETA MIRASOL VILLAGE	FACILITY NUMBER: 343627888
	VISIT DATE: 05/12/2026

NARRATIVE

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Toys are safe with no sharp edges, splinters, or points, nor made of small parts that can present a choking hazard. Drinking water is available in the classrooms via large water jugs and individual cups provided by the facility. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. The fire department provided an approved fire clearance for a capacity of 88 children to Licensing on April 1, 2026. LPA will submit a request to the fire department to approve the reduced capacity of 85.

The facility is equipped with 11 sinks and 7 toilets available to children. These are sufficient to accommodate the requested capacity of 85 children. Every classroom has two restrooms, each equipped with one toilet and one sink. One of the restrooms, located in Room 2, is a staff restroom and will not be utilized by children. There is a separate staff restroom equipped with a toilet and sink located near the Enrollment Office. The isolation area for children who are ill will be the Enrollment Office.

The facility will provide Breakfast, Lunch, and Snack each day. A weekly menu is posted near the facility entrance. Hazardous solutions and cleaning supplies are stored in a closet, inaccessible to children.

The facility playground is fenced to prevent children from accessing outside areas. Fencing was at least four feet high in all areas. LPA measured toddler outdoor activity space of 3,080.2 square feet, which is sufficient to accommodate the original requested capacity of 41 toddlers. LPA measured preschool outdoor activity space of 4,001.255 square feet, which is sufficient to accommodate the original requested capacity of 44 preschool children. Shade is provided via canopies and the building. There are sufficient outdoor toys and play equipment available on the playground. Drinking water is available outdoors via large water jugs and individual cups provided by the facility.

LR was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

Cont. on LIC809-C...

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

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: SETA MIRASOL VILLAGE	FACILITY NUMBER: 343627888
	VISIT DATE: 05/12/2026

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LR 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.

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.

LR 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 platforms. 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 and printed for LR, Betsy Uda.

The following corrections are needed prior to the issuance of the license:

-Updated Fire Clearance with reduced capacity.
-Submission of any additional requested documents.
-Final review and approval by Licensing Program Manager.

LR understands that all proof of corrections must be provided to the department within 30 days, or the application may be denied.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Josiah Gathing
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC809 (FAS) - (06/04)

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