255402253-3-10-2020-13-CC-DWIN-BMKPN4-20200310112718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 255402253
Report Date: 03/10/2020
Date Signed: 03/10/2020 11:27:40 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:	SURPRISE VALLEY PRESCHOOL		FACILITY NUMBER:	255402253
ADMINISTRATOR:	FUNK, DE		FACILITY TYPE:	850
ADDRESS:	790 HIGH STREET		TELEPHONE:	(530) 279-2030
CITY:	CEDARVILLE	STATE: CA	ZIP CODE:	96104
CAPACITY:	15	CENSUS: 9	DATE:	03/10/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Teacher Allison Walgenbach		TIME COMPLETED:	11:35 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	Licensing Program Analyst (LPA), David Wilson arrived at this facility for Required - 1 Year inspection. Caregiver background check clearances have been completed for all staff at this facility and these clearances are required as a condition of employment with Modoc County Office of Education. This facility is located in a portable building on the Surprise Valley Elementary School grounds. The facility’s operating hours are 8:00 am - 12:00 pm, Monday – Friday and follows the elementary school schedule. The facility was toured inside and outside. The items which could pose a danger to children (detergents, cleaning compounds and medications) were inaccessible to children. Teacher Walgenbach stated poisons are locked in a cabinet in the staff bathroom. LPA observed said cabinet and no poisons were observed accessible to children. The facility was free of infestation from flies, insects and rodents. The toys, floors, desks and other equipment and surfaces appeared clean, toxic free, safe and in good condition. The children’s bathrooms appeared in safe and sanitary condition. A current food menu was posted. Teacher Walgenbach stated uncontaminated drinking water is available to children both indoors and outdoors. A snack meal is provided by the family's for their individual children. Lunch is prepared by the school district and children eat in the school cafeteria. Garbage cans containing solid waste have tight fitting lids. The playground were free of hazards and the equipment and surface areas appeared in safe condition. The playground's climbing structures and/or play equipment have adequate cushioning underneath to sufficiently absorb falls. There were no bodies of water observed. Teacher Walgenbach stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were nine children being supervised by two teachers/aides. The facility was operating within the licensed capacity. Both staff members present possessed current CPR and First Aid certifications. Three children’s records were reviewed and in compliance. Two staff records were reviewed and in compliance. The sign in/out procedure was reviewed and in compliance. CONTINUED ON NEXT PAGE...

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David Wilson	TELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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: SURPRISE VALLEY PRESCHOOL	FACILITY NUMBER: 255402253
	VISIT DATE: 03/10/2020

NARRATIVE

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This facility is not providing Incidental Medical Services – IMS. IMS policy was discussed to include that no IMS treatments are to be administered by staff unless there is an IMS plan submitted and approved by this Department.

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 American Academy Pediatrics Guide to Safe Sleep practices brochure, were reviewed and discussed with Teacher Walgenbach.

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: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David Wilson	TELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

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