490107083-10-24-2019-01-CC-ASTR-BH9ULQ-20191024154107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490107083
Report Date: 10/24/2019
Date Signed: 10/24/2019 03:41:20 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:	J.X. WILSON EXTENDED CHILD CARE		FACILITY NUMBER:	490107083
ADMINISTRATOR:	CHRISTY CALVERLEY		FACILITY TYPE:	840
ADDRESS:	246 BRITTAIN LANE		TELEPHONE:	(707) 545-2402
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY:	96	CENSUS: 27	DATE:	10/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Cristina Northcroft		TIME COMPLETED:	04:00 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	A annual random inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. 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. Fingerprint clearances are all associated to the Wright facility #490107325. The facility provides care to the children in rooms 24 and 25 on the J.X. Wilson Elementary School Campus. The facility receives funding from the California Department of Education, and operates under title 5 and title 22. The facility’s operating hours are 7:00am-8:30am, Monday-Friday, 1:40pm-6:00pm Mon, Tues, Thurs, & Fri, and 11:40am-6:00pm on Wednesdays during the school year and is closed during the summer months. 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. The Director stated no poisons are stored on the premises and none were observed during today's inspection. The toys, floors, tables and other equipment and surfaces are clean, toxic free, safe and in good condition. There is drinking water available to children both indoors and outdoors provided by drinking fountains. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. The Director stated that although there is a climbing structure on the play ground, Extended Child Care does not use it during outside play. 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 27 children were being supervised by five teachers/aides. The facility was operating within the licensed capacity. At least one staff during the visit, the Director, Cristina Northcroft possessed current CPR and First Aid certifications, expireing 7/2020. Continue on LIC809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019

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: J.X. WILSON EXTENDED CHILD CARE	FACILITY NUMBER: 490107083
	VISIT DATE: 10/24/2019

NARRATIVE

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The sign-in/sign-out procedure was reviewed and in compliance. Seven children’s records were reviewed at 3:00pm, and contained signed admission agreements. The Director stated that staff files are stored off site at the Extended Child Care main office located at 1745 Copperhill Pkwy Ste. #5 Santa Rosa, CA 95403. LPA will visit the main office on a later date to verify documentation of staff education and training as required. This facility is providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Director and a copy of the requirements for developing a plan of operation for providing IMS was emailed to Extended Child Care Program Director, Nathan Murray during the inspection. (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 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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2019

LIC809 (FAS) - (06/04)

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