483009270-5-10-2019-01-CC-GOUE-BC2P9P-20190510110728

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483009270
Report Date: 05/10/2019
Date Signed: 05/10/2019 11:07:45 AM

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:	PUBLIC SAFETY ACADEMY STATE PRESCHOOL		FACILITY NUMBER:	483009270
ADMINISTRATOR:	MONTEGOMERY, AUDREY		FACILITY TYPE:	850
ADDRESS:	230 ATLANTIC AVENUE		TELEPHONE:	(707) 438-3684
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	24	CENSUS: 20	DATE:	05/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Stephanie Wheeler		TIME COMPLETED:	11:15 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	An Annual Random inspection was made to the facility by Licensing Program Analyst (LPA), Glenn Ouye. 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. This program is operated by the Fairfield-Suisun Unified School District State Preschools and is Title 5 funded program. The facility’s operating hours are 8:30 am to 11:30 am and 12 pm to 3 pm, Monday thru 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. There are no poisons at the facility. 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 in the play area. The children's bathrooms are in safe and sanitary condition. A current menu was posted in the facility. 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 is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn Ouye	TELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

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: PUBLIC SAFETY ACADEMY STATE PRESCHOOL	FACILITY NUMBER: 483009270
	VISIT DATE: 05/10/2019

NARRATIVE

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There were no bodies of water observed. The Principle stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and 20 children were being supervised by five teachers/para-educators. The facility was operating within the licensed capacity. All staff who were present during the visit possessed current CPR and First Aid certifications. Five children’s records were reviewed at 10 am, and contained identification forms with authorized representative information. Five staff records were reviewed at 9:45 am, and contained documentation of education and training, as required. This facility is providing Incidental Medical Services (IMS). The Department’s Incidental Medical Services (IMS) policy was discussed with the Licensee/Director. Storage of medication and equipment/supplies were in the directors office. 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 with the Principle. The Principle provided LPA with an copy of the Parent Handbook. 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: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

LIC809 (FAS) - (06/04)

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