053604817-1-15-2020-53-CC-JLDN-BKUUTH-20200115145156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 053604817
Report Date: 01/15/2020
Date Signed: 01/15/2020 02:52:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	MICHELSON EXTENDED DAY PROGRAM		FACILITY NUMBER:	053604817
ADMINISTRATOR:	MICHELE GIUFFRA		FACILITY TYPE:	840
ADDRESS:	196 PENNSYLVANIA GULCH ROAD		TELEPHONE:	(209) 728-8143
CITY:	MURPHYS	STATE: CA	ZIP CODE:	95247
CAPACITY:	49	CENSUS: 16	DATE:	01/15/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Amy Sturdivant		TIME COMPLETED:	03:15 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	Licensing Program Analyst (LPA) Justin Denton met with Site Supervisor Amy Sturdivant for the purpose of an annual random inspection. LPA toured the program site including all activity and classroom spaces, restrooms, and outdoor play areas. LPA observed appropriate ratios, care and supervision, and capacity during the visit. Medications, disinfectants, cleaning solutions, and hazardous items were appropriately stored and inaccessible to children. Furniture, equipment, and play materials were in good condition. Playground equipment was free of loose and sharp parts. The areas under and around playground climbing equipment were cushioned with materials to absorb falls. Toileting facilities were in operating, safe, and sanitary condition. All food was protected against contamination. Trash cans containing solid wastes had lids. Uncontaminated drinking water was readily available to children both indoors and outdoors. Breakfast, lunch, and snack menu was posted in a visible area. LPA observed Sign In/Out Sheet with signatures, times, and dates. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. The facility did not have any medication at this time. 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: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L Denton	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020

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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MICHELSON EXTENDED DAY PROGRAM	FACILITY NUMBER: 053604817
	VISIT DATE: 01/15/2020

NARRATIVE

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Children’s records were reviewed and were separate files, and included contact information of responsible parties. At least one person present today had current Pediatric CPR and First Aid certification (expires 01/27/20). LPA discussed the Departmental inspection authority, and also informed the Licensee that any changes regarding the Center Director or their Designee must be reported to Department within 10 working days.

An Exit Interview was conducted. A Notice of Site Visit was provided. Licensee was encouraged to the visit the Departmental website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, provider information notices, regulations and legislation pertaining child care centers.

The facility is in substantial compliance during today's inspection. No Title 22 Deficiencies were cited during today's visit.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L Denton	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020

LIC809 (FAS) - (06/04)

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