483008621-6-7-2019-01-CC-GOUE-BCWUBN-20190607152636

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483008621
Report Date: 06/07/2019
Date Signed: 06/07/2019 03:26:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	BENICIA USD - MATTHEW TURNER PRESCHOOL		FACILITY NUMBER:	483008621
ADMINISTRATOR:	REGIS, JUNE		FACILITY TYPE:	850
ADDRESS:	540 ROSE DRIVE		TELEPHONE:	(707) 747-8367
CITY:	BENICIA	STATE: CA	ZIP CODE:	94510
CAPACITY:	24	CENSUS: 15	DATE:	06/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Themla Bentley		TIME COMPLETED:	03:30 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	An annual random inspection was made to the facility by Licensing Program Analyst (LPA), Glenn Ouye. The facility file was reviewed prior to this inspection. A review of the personnel report 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 operated by the Benicia Unified School District. The facility’s operating hours are 6:30 am to 6:30 pm, Monday – Friday. 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 not kept in the facility. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors indoor drinking fountains at the sink and outdoors at a drinking fountain in the play area. The children’s bathrooms were in safe and sanitary condition. A current menu was posted in the classroom. Food prep is done by the elementary school cafeteria. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn Ouye	TELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: BENICIA USD - MATTHEW TURNER PRESCHOOL	FACILITY NUMBER: 483008621
	VISIT DATE: 06/07/2019

NARRATIVE

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There is wood chips cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The lead teacher stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were 15 children were being supervised by 2 teachers/aides. The facility was operating within the licensed capacity. Two staff member present during the visit possessed current CPR and First Aid certifications. Five children’s records were reviewed at 2:15 pm, and contained identification forms with authorized representative information, as well as medical assessments. Two staff records were reviewed at 2:25 pm, and contained health screening forms. The sign in/out procedure was reviewed and in compliance. This facility is providing Incidental Medical Services (IMS) to children. The Department’s IMS policy was discussed. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.) 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 and The Effects of Lead Exposure brochures, were reviewed and discussed. 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: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn Ouye	TELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

LIC809 (FAS) - (06/04)

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