041373685-9-17-2019-13-CC-SHUD-BG4VCV-20190917161947

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 041373685
Report Date: 09/17/2019
Date Signed: 09/17/2019 04:19:59 PM

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:	PEANUT BUTTER PALACE		FACILITY NUMBER:	041373685
ADMINISTRATOR:	JOHNSON, PEGGY		FACILITY TYPE:	850
ADDRESS:	3524 HICKS LANE		TELEPHONE:	(530) 899-0222
CITY:	CHICO	STATE: CA	ZIP CODE:	95973
CAPACITY:	36	CENSUS: 17	DATE:	09/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:			TIME COMPLETED:	04:30 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	An unannounced annual inspection was made to the facility by Licensing Program Analyst (LPA), Sandy Husband. The facility file was reviewed prior to this inspection. A review of the personnel report on 9/12/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility’s operating hours are 7:30 AM - 5:30 PM, Monday – Friday. The 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. There are no poisons located on the premises and none were observed during today's inspection. The facility was free of flies, insects and rodents. The toys, desks and other equipment and surfaces were clean, toxic free, safe and in good condition, however the floors and one rug were full of dirt and debris. There is uncontaminated drinking water available to children both indoors via individual labeled water bottles or individual cups located near the back sink and outdoors children have access to a pitcher of water with individual cups. The children’s bathrooms were in safe and sanitary condition. A current menu was posted on the bulletin board near the entrance where children are provided morning and afternoon snack and bring their lunches from home. 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 pea gravel cushioning underneath climbing structures and/or play equipment to absorbs falls and will be evenly distributed. There were no bodies of water observed. The head teacher stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were 17 children being supervised by 2 teachers and a third teacher (Continued on LIC 809-C)

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sandra Husband	TELEPHONE: 530-895-5822
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

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: PEANUT BUTTER PALACE	FACILITY NUMBER: 041373685
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/17/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/17/2019 Section Cited	1 2 3 4 5 6 7	The floors of all rooms shall have a surface that is safe and clean. This requirement was not met as evidenced by: Based upon owner failed to ensure flooring and carpet where children nap and play is free from dirt and debris. This poses a
	8 9 10 11 12 13 14	potential risk to children in care.	8 9 10 11 12 13 14
Type B 10/17/2019 Section Cited	1 2 3 4 5 6 7	At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based upon owner failed to ensure that C1-C3 had current CPR/1st Aid certification. This poses a potential risk to children in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sandra Husband	TELEPHONE: 530-895-5822
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

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: PEANUT BUTTER PALACE	FACILITY NUMBER: 041373685
	VISIT DATE: 09/17/2019

NARRATIVE

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(Continued from LIC 809)
arrived from lunch break during the inspection. The facility was operating within the licensed capacity. No staff members present during the visit (C1-C3) possessed current CPR and First Aid certifications. There was a working smoke detector, carbon monoxide detector and charged fire extinguisher in the facility. An emergency drill was conducted within the past 6 months on 4/8/19. Eight children’s records were reviewed at 3:00 PM, and contained identification forms with authorized representative information, as well as medical assessments. Three staff records were reviewed at 3:30 PM, and contained health screening forms. The sign in/out procedure was reviewed and in compliance. This facility is not providing Incidental Medical Services (IMS) to children. The Department’s IMS policy was discussed with the Head Teacher. (LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.) For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the Head Teacher. 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.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sandra Husband	TELEPHONE: 530-895-5822
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC809 (FAS) - (06/04)

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