041372369-10-18-2019-13-CC-DWIN-BH3MX5-20191018095923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 041372369
Report Date: 10/18/2019
Date Signed: 10/18/2019 09:59:35 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	PALERMO STATE PRESCHOOL		FACILITY NUMBER:	041372369
ADMINISTRATOR:	BUTCHER, KIMBERLY		FACILITY TYPE:	850
ADDRESS:	7350 BULLDOG WAY		TELEPHONE:	(530) 533-4730
CITY:	PALERMO	STATE: CA	ZIP CODE:	95968
CAPACITY:	48	CENSUS: 21	DATE:	10/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Site Supervisor Ronda Rodriguez		TIME COMPLETED:	10:10 AM

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	An Annual/Random inspection was conducted at the facility by Licensing Program Analyst (LPA), David Wilson. Prior to this inspection a review on 10/15/2019 of the personnel record on file indicates this facility is a public agency and all facility staff or other individuals who require caregiver background checks have received criminal record clearances through the Palermo Elementary School District. This facility's operating days and hours are Monday through Friday, 7:30am to 3:00pm, in Room #29 and 11:30am to 2:30pm in Room #30. Classroom #29 is currently a "full day/full year" operation. The entire facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. The site supervisor stated poisons are not stored on site and none were observed. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children’s bathrooms were in safe and sanitary condition. Children's meals are prepared at the Palermo Elementary School cafeteria and provided to each classroom in food carts where facility staff deliver the meals to children enrolled at this facility. Menus were posted in each classroom. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is adequate cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The site supervisor stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were seventeen children in classroom #29 being supervised adequately by four appropriately qualified staff. There were no children attending in classroom #30 at time of LPA's inspection. The facility was operating within the licensed capacity. Continued on next page...

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David Wilson	TELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: PALERMO STATE PRESCHOOL	FACILITY NUMBER: 041372369
	VISIT DATE: 10/18/2019

NARRATIVE

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At least one staff member present during the visit (S#) possessed current CPR and First Aid certifications. Six children’s records were reviewed and contained identification forms with authorized representative information, as well as medical assessments. The sign in/out procedure was reviewed and in compliance.

This facility is providing Incidental Medical Services (IMS) to children, however no children currently enrolled require IMS treatments.

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: www.ada.gov/childqanda.htm.

This report was reviewed and discussed with Site Supervisor Rodriguez.

All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David Wilson	TELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019

LIC809 (FAS) - (06/04)

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