085402644-10-5-2022-13-CC-KLYH-CJWUC7-20221005152727

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 085402644
Report Date: 10/05/2022
Date Signed: 10/05/2022 03:27:35 PM

Document Has Been Signed on 10/05/2022 03:27 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	MARY PEACOCK STATE PRESCHOOL		FACILITY NUMBER:	085402644
ADMINISTRATOR:	HIRT, LARA		FACILITY TYPE:	850
ADDRESS:	1720 ARLINGTON DRIVE		TELEPHONE:	(707) 464-0301
CITY:	CRESCENT CITY	STATE: CA	ZIP CODE:	95531
CAPACITY:	24	CENSUS: 15	DATE:	10/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Melissa Ferguson		TIME COMPLETED:	03:30 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	On 10/05/2022 at 2 PM, an annual inspection was made to the facility by Licensing Program Analyst (LPA) Kiriko Lynch. This program is operated by the local school district, Monday – Friday morning 8 AM to 11 AM, afternoon 12 PM to 3 PM. The facility was toured at 2 PM inside and outside and the floor and yard plan submitted by the licensee were verified. The facility representative and three staff were supervising 15 children and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises. The outdoor activity space was cushioned with chips. Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Ten children's records were reviewed at 2:45 PM. Four staff records were reviewed at 2:30 PM. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 See next page

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Kiriko Lynch	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MARY PEACOCK STATE PRESCHOOL	FACILITY NUMBER: 085402644
	VISIT DATE: 10/05/2022

NARRATIVE

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There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the facility representative Melissa Ferguson.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Kiriko Lynch	TELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

LIC809 (FAS) - (06/04)

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