185407852-11-8-2021-13-CC-CWIT-C8KKMM-20211108070146

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 185407852
Report Date: 11/05/2021
Date Signed: 11/08/2021 07:01:53 AM

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) 251-4050
CITY:	SUSANVILLE	STATE: CA	ZIP CODE:	96130
CAPACITY:	18	CENSUS: 5	DATE:	11/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Pamela McGuire		TIME COMPLETED:	12:20 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 11/5/21, at 9:45 am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart and met with Site Supervisor, Pamela McGuire. The facility file was reviewed prior to this inspection. A review of the personnel report on 11/5/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This program is operated by Head Start and is a Title 5 funded program. The facility’s operating hours are 7:45am - 3 pm, Mon-Fri. The facility was toured at 10:30 am inside and outside and the floor and yard plan submitted by the licensee were verified. There are no pools or similar bodies of water. The Director stated no firearms or weapons are stored on site and none were observed. The items which could pose a danger to children (such as disinfectants, cleaning solutions and medications) are inaccessible to children. Poisons are locked in janitor closet. Furniture and equipment are in good condition, free of hazards, and age appropriate. The outdoor activity space was cushioned with wood chips, rubber and grass and free of hazards. Toilets and sinks are in sanitary condition and operating properly. The facility floors were clean and safe. The kitchen/food preparation area is clean, and free of litter or rodents. Food is properly stored and free of contamination. Trash cans have tight fitting lids. There is uncontaminated drinking water available to children both indoors and outdoors via labeled sippy cups and purified water. The facility was free of flies, insects and rodents. The facility has a working carbon monoxide detector.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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 2

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: 11/05/2021

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
26
27
28
29
30
31
32

During today's inspection, staffing ratios were being met and there were no infants present but 5 toddlers were being supervised by 3 teachers/aides. Infants are not left without visual supervision at any time. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications (expires 10/21/22). The sign in/out sheet is electronically completed and representatives are using full signatures and recording the time. Staff are provided on-the-job training, including sanitation and universal precautions. Infants with symptoms of illness are not accepted, and children who become ill during the day are isolated in Site Supervisors office (Room #104). A weekly menu was posted by the entrance to the toddler and infant rooms.

The facility has a crib or mat/cot for each napping infant. Cribs are free of loose objects. Infants are visually supervised at all times while sleeping, and staff physically check on sleeping infants every 15 minutes. The 15 minute checks are documented on the Weekly Care Log and kept in the infant’s file. Infants under 12 months are placed on their backs for sleep, and no infants are swaddled.

Three infants and 3 toddler files were reviewed at 10:48 am, and contained emergency identification forms, medical assessments, and Needs and Services Plans with the exception of C1 who did not have a medical assessment on file. Infants up to 12 months have an Infant Sleeping Plan on file. Three infant and 3 toddler staff records were reviewed at 11:15 am, and contained proof of qualifications.

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 though an advisory was issued.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2