185407852-12-22-2020-13-CC-SHUD-BWK2ZY-20201222165106

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 185407852
Report Date: 12/21/2020
Date Signed: 12/22/2020 04:51:20 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:	LASSEN CTR/SIERRA CASCADE FAMILY OPPORTUNITIES INF		FACILITY NUMBER:	185407852
ADMINISTRATOR:	MCGUIRE, PAMELA		FACILITY TYPE:	830
ADDRESS:	478-200 HIGHWAY 139		TELEPHONE:	(530) 257-1206
CITY:	SUSANVILLE	STATE: CA	ZIP CODE:	96130
CAPACITY:	18	CENSUS: 0	DATE:	12/21/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Pam McGuire, Site Supervisor		TIME COMPLETED:	11:15 AM

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	The facility pre-licensing inspection was conducted on 12/21/20 at 9:15 AM via tele-inspection due to the current state of emergency regarding the COVID-19 outbreak by Licensing Program Analyst (LPA), Sandy Husband. The Department received an application for a change of location on 11/25/20 for an infant license requesting a capacity of 9 infants with a toddler component of 9 children for a total of 18. This is a combination facility with a separate preschool license. The facility was toured inside and outside. The center will operate from 7:45 AM to 4:00 PM, M-F. The infant facility consists of 2 classrooms serving ages 0-24 months with a toddler component serving 18-36 months. The fire clearance was approved on 12/17/20 for 18 infants, 9 of which are toddlers. The indoor capacity measured for 44 children and the outdoor yard area measured for 65 children. Therefore, the 18 requested capacity is approved. Required postings (Parents Personal Rights, Emergency Disaster Plan, Earthquake Preparedness Checklist, Menu, etc.) listed on Form LIC 311A are posted. The applicant was advised that all staff are required to have a criminal background clearance on file with Community Care Licensing (CCL). The applicant is aware of the immediate $100 per day civil penalty for anyone providing care or supervision without a criminal record clearance. The Site Supervisor meets the required qualifications. The applicant/Site Supervisor will maintain current on Pediatric CPR and First Aid and expires on 10/21/22. The Site Supervisor has obtained Mandated Reporter Training which expires 9/23/21. Children will use the fenced outdoor play area. Sign-In/Out procedure were reviewed. The applicant/Site Supervisor understands that if a manual Sign-In/Out procedure is used, full legal signatures are required. Cubbies are available for children to use. There are pull fire alarms, and there is a working carbon monoxide detector and charged fire extinguisher in the facility rated at least the 2A10BC. All Exits are marked. There is 1 bathroom available to children with 3 toilets and 6 sinks. There are two staff bathrooms, which are separate. There is uncontaminated drinking water available to children both indoors and outdoors via labeled sippy cups and purified water. The isolation area for a sick child will be established in the Site Supervisor's office in Room 104. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sandra Husband	TELEPHONE: 530-895-5822
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020

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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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: LASSEN CTR/SIERRA CASCADE FAMILY OPPORTUNITIES INF	FACILITY NUMBER: 185407852
	VISIT DATE: 12/21/2020

NARRATIVE

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(Continued from LIC 809)
The facility will be providing breakfast, lunch and snack on site. Bottles will be labeled and washed after each used and a three-step santization process is in use. Children will nap in cribs for those under 12 months of age and individual cots for children over 12 months. Bedding is kept separately and washed daily. A needs and services plan will be updated quarterly by the child's authorized representative.
(Continued from LIC 809)

Age appropriate toys and activities are available for children. There is wood chip, rubber and grass cushioning material underneath the play structures sufficient to absorb falls. There is material present to provide shade along with a canopy in the play yard. There are no bodies of water located on the property and none are to be added without prior notification and approval of the licensing agency. 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. This report, as well as the Guide to Safe Sleep Practices brochure and Lead Exposure Testing Flyer, were reviewed and discussed with the applicant/Site Supervisor. All licensing reports are public information and must be made available upon request for 3 years. All licensing reports are public information and must be made available upon request for at least three years. Licensure is granted for 18 children.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

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: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sandra Husband	TELEPHONE: 530-895-5822
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020

LIC809 (FAS) - (06/04)

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