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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 041373685
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:06:40 PM

Document Has Been Signed on 10/15/2024 04:06 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:PEANUT BUTTER PALACEFACILITY NUMBER:
041373685
ADMINISTRATOR/
DIRECTOR:		JOHNSON, PEGGYFACILITY TYPE:
850
ADDRESS:3524 HICKS LANETELEPHONE:
(530) 899-2022
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 6DATE:
10/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:31 PM
MET WITH:Lauren AlvaradoTIME VISIT/
INSPECTION COMPLETED:
04:16 PM
NARRATIVE
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On 10/15/24 @ 3:34 pm Licensing Program Analyst (LPAs) Bianca Mendez and Kayla Danielson conducted an unannounced case management inspection. An case management inspection regarding a incident was conducted on 10/15/24.
LPA conducted a case management on 10/15/24 for a unusual incident report and upon the site inspection, LPAs observed in the children's bathroom grime in the toilet bowls and mold on the floor of the bathroom that had tape. LPA observed a total of 6 children in care. LPA obtained photos of the children's bathrooms
The following deficiency was cited upon the facility inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and appeal rights were provided. This report was reviewed with the licensee, Lauren Alvarado.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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Document Has Been Signed on 10/15/2024 04:06 PM - It Cannot Be Edited


Created By: Bianca Mendez On 10/15/2024 at 03:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: PEANUT BUTTER PALACE
FACILITY NUMBER: 041373685

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/15/2024
Section Cited
CCR
101238(a)

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The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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Facility representative will address issue with licensee to ensure that the cleanliness of the bathroom is met and submit proof by 10/25/24 to CCLD.
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This requirement is not met as evidenced by: as based on faciltiy has grime on the toilet bowls and mold on the floor. Based on observation there was mold growing on the floor of the bathroom and grime in the toilet bowls
Which poses an potential Health and Safety risk to children in care.
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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
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024


LIC809 (FAS) - (06/04)
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