455407548-7-10-2019-13-CC-CKRD-BDXPYW-20190710114438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455407548
Report Date: 07/10/2019
Date Signed: 07/10/2019 11:44:41 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:	NORTH COTTONWOOD PRESCHOOL		FACILITY NUMBER:	455407548
ADMINISTRATOR:	RAY, DON		FACILITY TYPE:	850
ADDRESS:	19920 GAS POINT ROAD		TELEPHONE:	(530) 347-1698
CITY:	COTTONWOOD	STATE: CA	ZIP CODE:	96022
CAPACITY:	40	CENSUS: 12	DATE:	07/10/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Holly Smedley		TIME COMPLETED:	11:50 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	A pre-licensing inspection was conducted by Licensing Program Analyst (LPA Chris Krogstad, in response to an application received on 4/29/19, requesting a preschool license for 40 children. LPA Krogstad met with Director Holly Smedley. This will be a private pay preschool operated by Cottonwood Union School District in rooms 204 and 205 of the North Cottonwood Elementary school campus. Operating hours will be Mon-Fri, 7am-5:30pm, year-round and will be closed during school-year holidays. These two rooms were previously licensed by North Cottonwood YMCA. The fire clearance approval for the requested capacity of 40 was received on 7/10/19 at the facility. The two rooms were toured, inspected and measured for space. Both rooms measured sufficient for 20 children in each room for a total inside capacity of 40 children. There is one working sink and drinking fountain in each classroom for children. Children will use the elementary school restroom at the end of the building. This restroom will be shared with elementary school children, as well as children enrolled in the Cottonwood State Preschool, operated by Shasta County Office of Ed. The Director has requested a waiver to allow children to share the bathroom with separation ensured via supervision. Children will be escorted by staff for use of the restroom. There is a separate restroom for staff use. Children will have access to drinking fountains, inside and outside the classroom. The adjoining classroom/pod will be used as the isolation area for a sick child. The director stated poisons are not stored on site and none were observed. There is a working smoke detector/sprinkler system and fire extinguishers in the facility. A carbon monoxide detector was working and present in each room. Items that could pose a danger to children (cleaning compounds, medication, etc) were inaccessible. Sack lunches are brought from home. The center will provide AM/PM snack. There were no hazards observed in the classrooms. The director stated no firearms or ammunition will be stored on site and none were observed. See LIC 809C for further.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Christen Krogstad	TELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

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: NORTH COTTONWOOD PRESCHOOL	FACILITY NUMBER: 455407548
	VISIT DATE: 07/10/2019

NARRATIVE

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The play yard measured sufficient for 53 children. There are safe toys and age appropriate equipment. There is sufficient shade. There is bark cushioning under the teeter totter to absorb falls. There were no hazards or bodies of water observed in the outside play area. This play yard will be shared with preschool children enrolled in the Cottonwood State Preschool, operated by Shasta County Office of Ed. The Director has requested a waiver to allow children to share the play yard with separation ensured via scheduling. Unusual Incident Reporting and posting document requirements were discussed. Children and staff records to be maintained were reviewed. Staff qualifications and ratio requirements were reviewed. Incidental Medical Services (IMS) policy was discussed and an IMS plan was obtained for the license. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the 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.

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

The facility is ready for licensure

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Christen Krogstad	TELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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