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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475408098
Report Date: 05/25/2022
Date Signed: 05/26/2022 07:52:03 AM

Document Has Been Signed on 05/26/2022 07:52 AM - 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:SISKIYOU CREDIT UNION CHILD CARE CENTER PRESCHOOLFACILITY NUMBER:
475408098
ADMINISTRATOR:STONE, EMILYFACILITY TYPE:
850
ADDRESS:845 FOURTH STTELEPHONE:
(530) 842-1694
CITY:YREKASTATE: CAZIP CODE:
96097
CAPACITY: 3TOTAL ENROLLED CHILDREN: 3CENSUS: DATE:
05/25/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Emily StoneTIME COMPLETED:
04:30 PM
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A prelicensing inspection was conducted today at 3:00 p.m. by Licensing Program Analyst (LPA), N. Cunningham. LPA met with facility representative Emily Stone. Stone. The applicant is requesting a license for five infants and three preschool children, with a total capacity of eight children. The facility will operate Monday-Thursday, 7:45 a.m. to 5:15 p.m and Friday 7:45 a.m. – 6:15 p.m.. The facility has one classroom and one bathroom for children and one bathroom for staff.
The indoor and outdoor activity spaces were toured, and the facility sketch was verified. The following areas will be off limits to children: four front offices, side office and back office. These areas have been made inaccessible by means of child proof door latches. There is a kitchen to store meals. There is a nap room for infants to sleep with four cribs available. The isolation area for sick children will be located in the directors office. The changing table is located in the supply room and bathroom.

The facility representative submitted a waiver requesting to use the enclosed playground which is adjacent to the facility. The outdoor play area is fully fenced. There is a small play structures for children to play on and adequate cushioning underneath. The poisons are stored off site. There is safe and age appropriate furniture, toys, and play equipment available for children.

A capacity worksheet was completed during the visit. There is enough indoor and outdoor space for three preschool children. There are two toilets and two sinks available for children.

LPA reviewed with facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

*Continued on 809C
Erin Virrueta
Nicolette Cunningham
DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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: SISKIYOU CREDIT UNION CHILD CARE CENTER PRESCHOOL
FACILITY NUMBER: 475408098
VISIT DATE: 05/25/2022
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Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 ill be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant/licensee/facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant/licensee/facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following items need to be completed prior to the granting of a provisional license:
1. Proof of completion of CPR/FA
2. Emergency Disaster Plan - add Siskiyou County Public Health Contact information
3. Parent handbook - update immunization requirements and who can pick up child
4. Staff handbook- update immunization requirements
5. Management to review waiver request regarding outdoor play space.

A 90-day provisional license shall be granted upon submission of the above items. The provisional license cannot be extended. Prior to granting a regular license, the applicant shall provide proof of lead training certification to complete the requirement for current Preventative Health Practices.
SUPERVISOR'S NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
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: SISKIYOU CREDIT UNION CHILD CARE CENTER PRESCHOOL
FACILITY NUMBER: 475408098
VISIT DATE: 05/25/2022
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The following items need to be completed prior to the granting of a license:
1. update hours of operation
2. job description – include one job description for each position listed on personnel report (including the director), minimum qualifications must include the number of units required and length of experience
3. Personnel Policies – add employee’s rights and background clearances required (DOJ, FBI, Child Abuse Central Index)
4. Parent handbook – add rights of licensing agency
5. Admission Agreement – refund policy
6. Proof of completion of Health and Safety Training with Lead training

Exit interview conducted and report was reviewed with the facility representative, Emily Stone.
SUPERVISOR'S NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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