480106922-9-5-2019-13-CC-KMAS-BFQS3X-20190905133152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 480106922
Report Date: 09/05/2019
Date Signed: 09/05/2019 01:32:39 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:	SHEPHERD OF THE HILLS EARLY CHILDHOOD CENTER		FACILITY NUMBER:	480106922
ADMINISTRATOR:	WEBB, KATHRYN		FACILITY TYPE:	850
ADDRESS:	580 TRINITY DRIVE		TELEPHONE:	(707) 447-6278
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	65	CENSUS:	DATE:	09/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Kathryn Webb		TIME COMPLETED:	01:45 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	An annual/random inspection was made to the facility by Licensing Program Analyst (LPA), Kirk Marks. 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. The preschool is located on the grounds of the Shepherd of the Hills Lutheran Church. The facility operates in four separate classrooms. Operating hours are 8:30am to 11:30am and 11:30am to 2:00pm Mon-Fri. The facility is closed during normal school holidays and the summer. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Poisons are locked in a detached shed. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors from water fountains. The children's bathrooms are in safe and sanitary condition. A current snack menu was posted on the bulletin board at the entrance of the preschool. Food prep areas are clean. Food is properly stored and refrigerated as needed. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas are in safe condition. There are wood chips cushioning underneath climbing structures and play equipment 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 11 children were being supervised by two teachers/aides. The facility was operating within the licensed capacity. All staff member present during the visit possessed current CPR and First Aid certifications. (Continued on page 2)

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk Marks	TELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

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: SHEPHERD OF THE HILLS EARLY CHILDHOOD CENTER	FACILITY NUMBER: 480106922
	VISIT DATE: 09/05/2019

NARRATIVE

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(continued from page 2)

Twelve children’s records were reviewed at 12:10, and contained identification forms with authorized representative information. Five staff records were reviewed at 12:40, and contained documentation of education and training, as required. This facility is / is not providing Incidental Medical Services (IMS). The Department’s Incidental Medical Services (IMS) policy was discussed with the Licensee/Director. 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 Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk Marks	TELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019

LIC809 (FAS) - (06/04)

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