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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 041373685
Report Date: 11/05/2024
Date Signed: 11/05/2024 09:36:58 AM

Document Has Been Signed on 11/05/2024 09:36 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, 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:
11/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:45 AM
MET WITH:Peggy JohnsonTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
NARRATIVE
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On 11/5/24 at 7:45am Licensing Program Analyst (LPA) Bianca Mendez, conducted a plan of correction unannounced inspection relating to deficiencies discovered on 10/15/24. During a case management visit LPA Bianca Mendez observed in the children's bathroom grime in the toilet bowls and mold on the floor of the bathroom that had tape.

Licensee was issued a Type B citation on 10/15/24. LPA observed on 11/5/24 during the inspection, the licensee had cleaned the toilets but observed the mold on the floor. LPA reviewed child's file had physician's report. Staff vaccines are on file.LPA reviewed that disaster drills are in compliance.

During today's site visit LPA cited for the following deficiencies: Lead testing has not been completed and there is mold on the bathroom floor and observed the bathroom floors had dirt stains (see LIC 809D)
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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 11/05/2024 09:36 AM - It Cannot Be Edited


Created By: Bianca Mendez On 11/05/2024 at 08:22 AM
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: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2024
Section Cited
HSC
1597.16(a)(1)

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(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
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Licensee will submit a plan of correction and contact a lead tester within 10 days to conduct the lead testing. Submit proof to CCLD by 11/6/24
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Based on record the licensee did not comply with the section cited above in which facility did not completed lead testing which poses a l health, immediate safety or personal rights risk to persons in care.
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Parents/Guardians must sign the LIC 9224 to be kept in each child's file.
Type A
11/05/2024
Section Cited
CCR101238(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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Licensee will have someone come in and clean the floors of the children's bathroom and proof to CCLD by 11/6/24.
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This requirement is not met as evidenced by: as based on faciltiy has mold. Based on observation there was mold growing and taped on the vinyl floor of the children's bathroom
Which poses an immediate Health and Safety risk to children in care.
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Parents/Guardians must sign the LIC 9224 to be kept in each child's file.
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: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2024


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: 11/05/2024
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LPA Bianca Mendez informed licensee Peggy Johnson that this report dated 11/5/24 documents 2 Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

LPA Bianca Mendez informed the licensee to provide a copy of this licensing report dated 11/5/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.



Exit interview conducted and report was reviewed with the licensee Peggy Johnson. Appeal Rights were provided. Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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