073408876-7-21-2021-02-CC-PPEN-C55V7B-20210721161054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408876
Report Date: 07/21/2021
Date Signed: 07/21/2021 04:10:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SKYTOWN PRESCHOOL		FACILITY NUMBER:	073408876
ADMINISTRATOR:	MELGOZA, MARTHA		FACILITY TYPE:	850
ADDRESS:	5714 SOLANO AVENUE		TELEPHONE:	(510) 701-4855
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94805
CAPACITY:	36	CENSUS: 4	DATE:	07/21/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Roland Bergfelt		TIME COMPLETED:	04:10 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) Paul Petersen conducted an annual required site inspection for this facility at 2:25 PM. LPA met with teacher, Roland Bergfelt, who was present along with four preschool age children in care and one additional teaching staff. This program is a parent cooperative. No parents were present during this inspection. The facility is within ratio and capacity and children are being directly supervised. All adults present at this program are background cleared and associated. This program is a preschool with a licensed toddler option which operates out of a single building. There were no toddlers in care during this inspection. The toddler indoor and outdoor areas are distinctly separate from preschool indoor and outdoor areas. The toddler classroom is currently not in use. The preschool classroom has age-appropriate furnishings, equipment and play items which are free of broken or sharp pieces. The record of most recent fire department inspection is dated 2019. There are smoke detectors and carbon monoxide detectors in both classrooms. All were checked by LPA. Fire Extinguishers are fully charged. Counters and surfaces, including floors, are free of toxins and observed hazardous conditions. There were no toxins/cleaning agents/hazardous materials observed to be accessible to children. Bathrooms are age appropriate and toilets and faucets are in working condition. In door and outdoor drinking water is available by children's individual drinking bottles. The facility operates from 9:00am-1:00pm with an extended care from 8:00-9:00am and 1:00pm - 3:00pm. Children bring their own meals/snack items and the facility has food items available as backup. Children do not nap at the facility. The facility appears to be free of pests. Continued on Page 2********************************************************************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SKYTOWN PRESCHOOL	FACILITY NUMBER: 073408876
	VISIT DATE: 07/21/2021

NARRATIVE

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Facility personnel and children's records were reviewed. Children's files were reviewed for emergency identification forms, admissions agreements and immunization records. Personnel records were reviewed for health screening forms, immunization records and teacher qualification documents. At least one staff present has current CPR/1st Aid certification.

This facility provides Incidental Medical Services-IMS. 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 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

Staff are encouraged to visit www.ccld.ca.gov for licensing updates and forms. To subscribe to receive licensing PINs use: https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe https://www.cdss.ca.gov/inforesources/community-care/self-assessment-guides-and-key-indicator-tools/quarterly-updates.
Contra Costa Public Health COVID Guidance for Childcare Facilities: www.coronavirus.cchealth.org/for-schools-and-childcare

No deficiencies were cited during today's inspection. A copy of the appeal rights was provided and a notice of site visit which is to remain posted for 30 days. A copy of this report was is to be maintained in the facility records for a period of three years.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

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