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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173002889
Report Date: 01/23/2020
Date Signed: 01/23/2020 01:29:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:YUBA COMMUNITY COLLEGE,LAKE CAMPUS CDCFACILITY NUMBER:
173002889
ADMINISTRATOR:BLAKE, CHERYLFACILITY TYPE:
850
ADDRESS:15880 DAM ROAD EXTENSIONTELEPHONE:
(707) 995-7909
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY:30CENSUS: 20DATE:
01/23/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:April Jensen, Child Development AssistantTIME COMPLETED:
01:45 PM
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A case management inspection was conducted by Licensing Program Analysts (LPA) N. Cunningham as a follow-up to an inspection visit conducted on 01/08/20. On 01/08/20, LPA issued two technical violations for the following issues:

1. On 01/08/20, there was a large gap in-between the gate and fence. On 01/21/20, the director e-mailed pictures of the fence which showed the gate had been repositioned to eliminate the gap in-between the gate and fence. During today's inspection, the area was toured and photographed. LPA observed a small gap (approximately 3 inches) in-between the gate and the fence. This issue has been resolved.

2. On 01/08/20, LPA observed two book cases and two cubbies that were not secured to the wall or floor. On 01/21/20, the director e-mailed pictures of the furniture. LPA reviewed the pictures and was unable to determine if the furniture was adequately anchored. During today's inspection, LPA observed the cubbies anchored to the wall. The two book cases were secured together and did not move when LPA firmly pushed against them. LPA photographed the bookcases at 12:58pm. This issue has been resolved.

This report was reviewed and discussed with the child development assistant. Notice of Site Visit shall be posted for 30 days from today's inspection. There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
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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