455407548-8-30-2021-13-CC-CWIT-C6DTCQ-20210830143706

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455407548
Report Date: 08/30/2021
Date Signed: 08/30/2021 02:37:11 PM

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:	BARNES, REBECCA		FACILITY TYPE:	850
ADDRESS:	19920 GAS POINT ROAD		TELEPHONE:	(530) 347-1698
CITY:	COTTONWOOD	STATE: CA	ZIP CODE:	96022
CAPACITY:	40	CENSUS: 19	DATE:	08/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:53 AM
MET WITH:	Rebecca Barnes		TIME COMPLETED:	12:30 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 8/30/321 date at 10:53 am, annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart and met with Director, Rebecca Barnes. The facility file was reviewed prior to this inspection. A review of the personnel report on 8/30/21 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 is a private pay preschool operated by Cottonwood Union School District in rooms 204 and 205 of the North Cottonwood Elementary school campus. Operating hours are Mon-Fri, 7 am-5:30pm, year-round and will be closed during school-year holidays. The facility was toured at 11:15 am time inside and outside and the floor and yard plan submitted by the licensee were verified. The Director stated no firearms or weapons are stored on site and none were observed. There are no pools or similar bodies of water. This restroom is shared with elementary school children, as well as children enrolled in the Cottonwood State Preschool, operated by Shasta County Office of Ed and a waiver is on file to share the bathroom with separation ensured via supervision. Children are escorted by staff for use of the restroom. The items which could pose a danger to children (such as disinfectants, cleaning solutions and medications) are inaccessible to children. The Director stated poisons are not stored on site. Furniture and equipment are in good condition and free of hazards. The outdoor activity space was cushioned with wood chips 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. Drinking water is available inside and outside to children via water bottles. 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: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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: 08/30/2021

NARRATIVE

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During today's inspection, staffing ratios were being met and there were 19 children were being supervised by 3 teachers/aides. Children 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 (S#1) possessed current CPR and First Aid certifications (expires 6/23). The sign in/out sheet was reviewed, and representatives are using full signatures and recording the time. Staff are provided on-the-job training, including sanitation and universal precautions. Children with symptoms of illness are not accepted, and children who become ill during the day are isolated in the adjoining classroom/pod . A weekly menu was posted on parent board. Sack lunches are brought from home. The center provides AM/PM snack.
7 children’s records were reviewed at 11:34 am, and contained emergency identification forms and medical assessments. Three staff records were reviewed at 11:27 am , and contained health screening forms, proof of mandated reporter training, and proof of immunization's.

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: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

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