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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121373638
Report Date: 10/24/2019
Date Signed: 10/24/2019 11:54:24 AM

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:MISTWOOD MONTESSORI SCHOOLFACILITY NUMBER:
121373638
ADMINISTRATOR:FRINK, PATRICIA H.FACILITY TYPE:
850
ADDRESS:1801 TENTH ST.TELEPHONE:
(707) 444-8100
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:50CENSUS: 36DATE:
10/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Julie EltzenTIME COMPLETED:
12:15 PM
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An inspection visit was made to the facility by LPA Snow who met with Julie Eltzen. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
During today's visit staffing ratios were being met with seven teachers watching 36 children in three separate rooms.
Operating hours July 9am-Noon & August closed & the rest of the year on M-F, 8:30am- 4:30pm. The facility was toured inside and outside. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were inaccessible to children and no poisons were observed; Julie said there are none on the grounds. Julie stated no weapons are stored on site and none were observed. The toys, floors, desks and other equipment appeared clean and safe. There is drinking water fountains available to children both indoors and outdoors. The children's bathrooms appeared in safe and sanitary condition. The facility serves snacks; food prep areas are clean & children bring lunches. Food is properly stored.
There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. The playground is completely fenced and free of hazards. The playground equipment appeared in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment. There were no bodies of water observed. Children and staff records were reviewed at 11:20am
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
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: MISTWOOD MONTESSORI SCHOOL
FACILITY NUMBER: 121373638
VISIT DATE: 10/24/2019
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Incidental Medical Services (IMS) policy was discussed. The LPA


. 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. SIDS pamphlet was provided. This report was reviewed and discussed with the Jule. All licensing reports are public information and must be made available upon request.

No violations were observed during todays visit.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following is required to be updated within 30 days;
IMS Plan (incidental medical services)
LIC 500 Personnel report.
LIC 308 Designation of responsibility
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019
LIC809 (FAS) - (06/04)
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