475408007-1-6-2022-13-CC-NCUM-CAENSW-20220106094349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 475408007
Report Date: 01/06/2022
Date Signed: 01/06/2022 09:43:55 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:	WILLOW CREEK ELEMENTARY SCHOOL DISTRICT PRESCHOOL		FACILITY NUMBER:	475408007
ADMINISTRATOR:	BRANDTS, LINDA		FACILITY TYPE:	850
ADDRESS:	5321 YORK RD.		TELEPHONE:	(530) 459-3313
CITY:	MONTAGUE	STATE: CA	ZIP CODE:	96064
CAPACITY:	20	CENSUS: 0	DATE:	01/06/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Linda Brandts and Amanda Elsemore		TIME COMPLETED:	10:00 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	Licensing Program Analyst (LPA) N. Cunningham met with Amanda Elsemore to conduct a prelicensing inspection of the facility. The application for the Preschool was received by the department on October 29. 2021. The program will operate in classroom #3 at Willow Creek Elementary School. All staff will be fingerprinted through the school district prior to working at the center. The program will operate 08:30am-12:30pm, Monday-Friday, and will operate concurrently with the elementary school calendar. The facility interior has one classroom with two restrooms (2 toilets and 2 sinks). There is a separate restroom for staff to use. The interior square footage supports 16 children. There is sufficient furniture, equipment, and toys for the children. The outdoor activity area support over the requested square footage requirement. A capacity determination worksheet will be included with the file. There are smoke and fire extinguishers rated at 2A10BC. The teacher reports that the CalFire Fire Inspector approved the classroom for use for 16 children on 01/05/22 and is in the process of sending STD850 to the department. *Continued on 809C

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Nicolette Cunningham	TELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

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: WILLOW CREEK ELEMENTARY SCHOOL DISTRICT PRESCHOOL	FACILITY NUMBER: 475408007
	VISIT DATE: 01/06/2022

NARRATIVE

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The sign in and sign out will be completed at the entryway by the front door. The applicant is aware of the sign in and sign out requirements. Covid-19 wellness checks will also be done in conjunction with the daily sign in.

The outdoor area has multiple areas with adequate shade. The children will use personalized water bottles or cups for hydration.

LPA Cunningham discussed recommendations regarding Covid-19. The facility will conduct daily wellness screening including health questions during sign-in/drop off. The children will be wearing masks at all times except while eating, drinking and napping. The staff will do continuous cleaning and sanitizing throughout the day to reduce the transmission of Covid-19.

The following items will need to be verified for licensure:
provide proof of completion of preventative health and safety training
fire clearance (STD850)
install a carbon monoxide detector
provide a copy of current water testing results
secure large furniture
provide an updated daily schedule
install electrical outlet covers

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Nicolette Cunningham	TELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022

LIC809 (FAS) - (06/04)

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