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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475404391
Report Date: 11/15/2019
Date Signed: 11/22/2019 03:34:16 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:BUTTE VALLEY MONTESSORI CHILDREN'S HOUSE, INC.FACILITY NUMBER:
475404391
ADMINISTRATOR:ZARZYNSKI, DAINTRYFACILITY TYPE:
850
ADDRESS:610 W. THIRD ST.TELEPHONE:
(530) 397-2293
CITY:DORRISSTATE: CAZIP CODE:
96023
CAPACITY:60CENSUS: 27DATE:
11/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Daintry ZarzynskiTIME COMPLETED:
11:00 AM
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An inspection was made to the facility by Licensing Program Analyst, LPA,Snow. The facility file was reviewed prior to this visit. A review of the personnel report on file 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 a private facility directly across the street from the elementary school and runs concurrent with the public elementary school schedule.

Operating hours are 7:30 AM - 4:30 PM, Mon-Fri. The facility was toured inside and outside and the floor and yard plan were verified. The items which could pose a danger to children (detergents, cleaning compounds and medications) were inaccessible to children. Poisons are locked in the janitor's closet. The toys, floors, desks and other equipment and surfaces appeared clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children's bathrooms appeared in safe and sanitary condition. Food is prepared on site with breakfast, lunch and PM snack provided. The food prep areas are clean. They have a kitchen and the food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. There is a working smoke detector, carbon monoxide detector and charged fire extinguisher in the facility. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment sufficient 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 children were being properly supervised.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: BUTTE VALLEY MONTESSORI CHILDREN'S HOUSE, INC.
FACILITY NUMBER: 475404391
VISIT DATE: 11/15/2019
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The facility was operating within the licensed capacity with 5 staff watching 27 children. At least one staff member present possessed current CPR and First Aid certifications expiring in 3/24/20. The sign-in/sign-out procedure was reviewed and in compliance. Children’s records were reviewed and contained identification forms with authorized representative information. Staff records were reviewed and contained documentation of education and training, as required. This facility is not providing Incidental Medical Services – IMS.

Incidental Medical Services (IMS) policy was discussed. They are not currently doing IMS and the director agrees to submit a plan first. 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, as well as the AAP Guide to Safe Sleep Practices brochure, were 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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
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