<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125407397
Report Date: 09/27/2021
Date Signed: 09/27/2021 03:08:42 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:SMITH LANE EARLY HEAD STARTFACILITY NUMBER:
125407397
ADMINISTRATOR:CROTTY, BETHFACILITY TYPE:
850
ADDRESS:3040 SMITH LANETELEPHONE:
(707) 725-7969
CITY:FORTUNASTATE: CAZIP CODE:
95540
CAPACITY:8CENSUS: 4DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Beth Crotty/Naomi FaulknerTIME 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 09/27/21 at 12:30 PM], an annual inspection was made to the facility by Licensing Program Analyst (LPA) Kiriko Lynch. This program is operated by Head Start and a Title 5 funded program are 8:15 AM to 3:15 PM, Monday–Friday. The facility was toured at 1:30 PM inside and outside and the floor and yard plan submitted by the licensee were verified. Facility operates in two classrooms, and two additional rooms in the building.
The facility representatives were supervising four children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises. Four children's records were reviewed at 2:15 PM. Four staff records were reviewed at 2:45 PM. 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. 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 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. There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Beth Crotty and Naomi Faulkner. 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 VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1