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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173003503
Report Date: 05/17/2019
Date Signed: 05/17/2019 12:16:54 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:MIDDLETOWN EARLY CONNECTIONFACILITY NUMBER:
173003503
ADMINISTRATOR:PERRY, LIBERTYFACILITY TYPE:
850
ADDRESS:15846 WARDLAW STREETTELEPHONE:
(707) 987-9749
CITY:MIDDLETOWNSTATE: CAZIP CODE:
95461
CAPACITY:30CENSUS: 0DATE:
05/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Slobodanka ToshichTIME COMPLETED:
12:30 PM
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An annual inspection was made to the facility by Licensing Program Analyst (LPA) Chris Arnhold. The facility file was reviewed prior to this visit. The facility is a Title 5 facility. Staff are fingerprinted through Department of Education. The facility operates Monday - Friday; 8:00am - 11:00am. Facility staff were conducted Parent Conferences at the time of this inspection and no children were present. There are no: bodies of water, weapons, firearms, or poisons, on site. Disinfectants, toxins and other hazards were not accessible to children. Materials and surfaces appear safe and toxic free. There is uncontaminated drinking water available to children both indoors and outdoors using drinking fountains. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. Food items were stored properly to prevent contamination. Menus for the week are posted. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector and fire extinguisher rated at least 2-A:10-B:C in the facility. There is a hardwired fire alarm system with pull stations. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is cushioning underneath climbing structures and/or play equipment to absorb falls. All staff member present during the visit possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. At approximately 10:20am, 7 children’s records were reviewed and contained signed admission agreements, notice of parental rights and immunization records. Five staff records were reviewed at approximately 10:40am and contained documentation of education and training as required. This facility is not providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Site Supervisor. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the site supervisor. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.
There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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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