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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173009810
Report Date: 07/08/2021
Date Signed: 07/09/2021 08:21:46 AM

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:LAKEPORT CHRISTIAN CENTER PS/DAYCAREFACILITY NUMBER:
173009810
ADMINISTRATOR:MARY PAARSCHFACILITY TYPE:
840
ADDRESS:455 SOUTH FORBES STREETTELEPHONE:
(707) 262-5520
CITY:LAKEPORTSTATE: CAZIP CODE:
95453
CAPACITY:18CENSUS: 9DATE:
07/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sharon McIntosh, Lead TeacherTIME COMPLETED:
11:15 AM
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A required inspection was made to the facility by Licensing Program Analyst (LPA), N. Cunningham. The facility file was reviewed prior to this inspection. A review of the personnel report on 07/06/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility’s operating hours are 07:30AM- 05:30PM, Monday – Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Lead Teacher stated poisons are not stored on site. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. Children have access to drinking water indoors and outdoors. Children have access to cups to obtain drinking water in a classroom sink. The children’s bathrooms were in safe and sanitary condition. Children bring their lunches, the center provides snack. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is a gravel rock underneath climbing structures and play equipment to absorb falls. There were no bodies of water observed. The lead teacher stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were 9 children being supervised by two teachers. The facility was operating within the licensed capacity. The lead teacher has current pediatric CPR and First Aid certification, which expires on 05/2023. Four children’s (C1 - C4) records were reviewed at 10:20am, and contained identification forms with authorized representative information. The sign in/out procedure was reviewed and found to be in compliance. This facility is not providing Incidental Medical Services (IMS) to children. The Department’s IMS policy was discussed with the Center Director. (Continue to LIC 809-C)
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LAKEPORT CHRISTIAN CENTER PS/DAYCARE
FACILITY NUMBER: 173009810
VISIT DATE: 07/08/2021
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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 Effects of Lead Exposure brochures, were reviewed and discussed with the lead teacher. 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.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
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