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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008822
Report Date: 06/06/2019
Date Signed: 06/13/2019 09:26:36 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:ANDERSON CDCFACILITY NUMBER:
483008822
ADMINISTRATOR:MOORE, LAURIEFACILITY TYPE:
850
ADDRESS:415 EAST C STREETTELEPHONE:
(408) 556-7300
CITY:DIXONSTATE: CAZIP CODE:
95620
CAPACITY:60CENSUS: 21DATE:
06/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Meghan Kelly, Site SupervisorTIME COMPLETED:
12:10 PM
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An Annual Random inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez. This is a combination center. The inspection was made in conjunction with the school-age component. The facility file was reviewed prior to this inspection. A review of the Facility Personnel Report Summary on 6/5/2019 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 facility is located in portable building P1 and P2, located at Anderson Elementary School. The facility operates year round, Monday - Friday. The full-day program operates 7:00am - 6:00pm, the part-day program operates 8:30am - 11:30am. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. 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 cabinets located in cabinets located under the sink. 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 and outdoors. The children’s bathrooms were in safe and sanitary condition. Current menus are posted on the bulletin board located between P1 and P2. Food prep areas are clean. 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. There are no climbing structures in the outdoor play area. No climbing structures will be added without prior notification to the Department. There were no bodies of water observed. Site Supervisor stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met. Twenty-one (21) children were being supervised by three teachers and one aide . At least one staff member present during the visit (S#1) possessed current CPR/First Aid certifications. Ten children’s records were reviewed at 11:35am, and contained identification forms with authorized representative information, as well as medical assessments. Staff records were reviewed contained health screening forms. The sign in/out procedure was reviewed and in substantial compliance. This facility is not providing Incidental Medical Services (IMS) to children. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding the American Disabilities Act (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 was reviewed and discussed with Site Supervisor Meghan Kelly. 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: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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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