455402544-5-1-2019-13-CC-PPAO-BBRNN3-20190501103603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455402544
Report Date: 05/01/2019
Date Signed: 05/01/2019 10:36:10 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:	CASTLE ROCK COMMUNITY PRESCHOOL		FACILITY NUMBER:	455402544
ADMINISTRATOR:	FUNK, AUTUMN		FACILITY TYPE:	850
ADDRESS:	29373 MAIN ST.		TELEPHONE:	(530) 235-0101
CITY:	CASTELLA	STATE: CA	ZIP CODE:	96017
CAPACITY:	17	CENSUS: 9	DATE:	05/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Lisa Smyth		TIME COMPLETED:	10:40 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	An inspection was conducted at the facility by Licensing Program Analyst (LPA), Patricia Pacheco. The facility file was reviewed prior to this inspection. A review of the personnel report on 04/30/19, 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 the Castle Rock Union Elementary School District and is located in room 5 on the Castle Rock Elementary School campus. The facility’s operating hours are 8:30 am - 2:30 pm, Monday – Friday; and follows the school calendar. 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. Poisons are locked in the school's janitorial closet. 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. There is uncontaminated drinking water available to children both indoors and outdoors via water fountain. The children’s bathrooms were in safe and sanitary condition. A current menu was posted next to the door. 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 wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The director 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 were being supervised by the director and an aide. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Patricia Pacheco	TELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

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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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: CASTLE ROCK COMMUNITY PRESCHOOL	FACILITY NUMBER: 455402544
	VISIT DATE: 05/01/2019

NARRATIVE

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certifications. Six children’s records were reviewed at 9:30 am, and contained identification forms with authorized representative information, as well as medical assessments. Two staff records were reviewed at 9:40 am and contained health screening forms. The sign in/out procedure was reviewed and in compliance. This facility is not providing Incidental Medical Services (IMS) to children. The Department’s IMS policy was discussed with the director. 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 was reviewed and discussed with the director. 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: Patricia Pacheco	TELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019

LIC809 (FAS) - (06/04)

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