455406236-6-5-2023-13-CC-BMEZ-CSHQHQ-20230605121130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455406236
Report Date: 06/05/2023
Date Signed: 06/05/2023 12:11:34 PM

Document Has Been Signed on 06/05/2023 12:11 PM - It Cannot Be Edited

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:	SCOE - NORTH COTTONWOOD PRESCHOOL		FACILITY NUMBER:	455406236
ADMINISTRATOR:	GROVES, BRANDY		FACILITY TYPE:	850
ADDRESS:	19920 GAS POINT ROAD		TELEPHONE:	(530) 347-3144
CITY:	COTTONWOOD	STATE: CA	ZIP CODE:	96022
CAPACITY:	22	CENSUS: 6	DATE:	06/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Krista Gerner		TIME COMPLETED:	12:20 PM

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On 6/5/23 at 10:46am, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Mendez and LPA Sims. (This program is operated by public agency and a Title 5 funded program. Hours of operation are 8am-11:30am, Monday–Friday. The facility was toured at 11:50am inside and outside and the floor and yard plan submitted by the licensee were verified. The facility representative and staff were supervising 6 children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises. The outdoor activity space was cushioned with grass and free of hazards.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca Mendez	TELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

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: SCOE - NORTH COTTONWOOD PRESCHOOL	FACILITY NUMBER: 455406236
	VISIT DATE: 06/05/2023

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There were no deficiencies cited during today’s inspection.

Exit interview conducted and report was reviewed with the facility representative Krista Gerner

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca Mendez	TELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC809 (FAS) - (06/04)

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