045407832-1-13-2021-13-CC-SHUD-BX92Q7-20210113163524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045407832
Report Date: 11/04/2020
Date Signed: 01/13/2021 04:35:36 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:	HONCUT SCHOOL AGE CARE		FACILITY NUMBER:	045407832
ADMINISTRATOR:	KIMBERLY BUTCHER		FACILITY TYPE:	840
ADDRESS:	68 SCHOOL STREET		TELEPHONE:	(530) 742-5284
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY:	28	CENSUS: 0	DATE:	11/04/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Kimberly Butchers, Director		TIME COMPLETED:	01:00 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	The facility pre-licensing inspection was conducted via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak by Licensing Program Analyst (LPA), Sandy Husband. The applicant submitted an application for an initial license of 28 school age children that was received on 10/27/20. The facility is a combination center with a separate preschool license including a toddler component. This is a Title 5 program on Honcut Elementary School campus. The facility was toured inside and outside. The operational hours are from 7:30 AM to 5:30 PM, Monday - Friday. The shool-age facility consists of 1 classroom. Room 2 serves the school-age children. The fire clearance was approved for a total of 28 children on 10/29/20. The shool-age classroom is exempt from measurement qualifications because it meets the criteria of being located on a school ground in a classroom. The outdoor yard area measured for 291 school-agers. Required postings (Parents Personal Rights, Emergency Disaster Plan, Earthquake Preparedness Checklist, Menu, etc.) listed on Form LIC 311A will be posted. The applicant was advised that all staff are required to have a criminal background clearance on file with Community Care Licensing (CCL). The applicant is aware of the immediate $100 per day civil penalty for anyone providing care or supervision without a criminal record clearance. The applicant has met the the educational requirements to qualify as a Director. The applicant completed the Preventive Health Practices on 5/7/11. The applicant does not have current Pediatric CPR and First Aid, as it expired 6/2020. However, she will obtain and maintain current CPR/1st Aid. All other staff have current CPR/1st Aid and expires on 5/6/21. The Applicant has mandated reporter training which expires on 10/8/22. Children will use the fenced outdoor play area. Sign-In/Out procedure were reviewed and the facility will be using an electronic program. The applicant understands that if a manual Sign-In/Out procedure is used, full legal signatures are required. There are pull fire alarms, and there is a working carbon monoxide detector and charged fire extinguisher in the facility rated at least the 2A10BC. All Exits are marked. There are 2 bathrooms available to school-agers and privacy is provided. There is one staff bathroom, which is separate and located in Room 1. There is uncontaminated drinking water available to children both indoors via a water cooler; outdoors via a water fountain to refill water bottles. The isolation area for a sick child will be in Room 1. The facility has a current menu serving breakfast, lunch, mid-morning and PM snack and will be served on site and prepared at the Helen Wilcox (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: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

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: HONCUT SCHOOL AGE CARE	FACILITY NUMBER: 045407832
	VISIT DATE: 11/04/2020

NARRATIVE

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(Continued from LIC 809)
Elementary School kitchen. Age appropriate toys and activities will be available for children. There are trees present to provide shade in the play yard. The play yard will have individual fencing to separate the toddler yard from the school yard. There are no bodies of water located on the property and none are to be added without prior notification and approval of the licensing agency. Upon submission of the required items listed below, capacity will be granted for a total of 28 school-age children based on the fire clearance. 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: http://www.ada.gov/childqanda.htm. This report and the Lead Exposure Testing Flyer, were reviewed and discussed with the applicant. All licensing reports are public information and must be made available upon request for at least three years.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

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

The following items must be submitted prior to licensure:

1. Enrollment in a current CPR/First Aid for the Applicant and completion within 90 days.
2. Proof of TB submitted to the Department
3. Completion of Component I Orientation for Centers.
4. Enrollment in current Lead training.

A 90-day provisional license shall be granted upon submission of the above items. The provisional license cannot be extended. Prior to granting a regular license, the applicant shall provide proof of lead training certification to complete the requirement for current Preventative Health Practices.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sandra Husband	TELEPHONE: 530-895-5822
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

LIC809 (FAS) - (06/04)

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