490111249-12-21-2023-01-CC-SPHG-CYQUQL-20231221144719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 490111249
Report Date: 12/21/2023
Date Signed: 12/21/2023 02:47:24 PM

Document Has Been Signed on 12/21/2023 02:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	SAN MIGUEL EXTENDED CHILD CARE		FACILITY NUMBER:	490111249
ADMINISTRATOR:	JASON RIGGS		FACILITY TYPE:	840
ADDRESS:	5350 FAUGHT ROAD		TELEPHONE:	(707) 546-0667
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	128	CENSUS: 45	DATE:	12/21/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Sonja Kaluahine		TIME COMPLETED:	03:00 PM

NARRATIVE

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A required inspection was made to the facility by Licensing Program Analyst (LPA), Sebastian Phouthavong. LPA met with facility representative, Sonja Kaluahine. Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

This program is operated by Extended Child Care Coalition of Sonoma County, a nonprofit agency. Staff files are stored off site at the Extended Child Care main office. LPA will make continuation visit to review staff files.

The facility currently is operating year-round, Monday-Friday from 7:00-8:45am and again from 1:15-6:00pm Monday, Tuesday, Thursday, and Friday and 12:45-6:00pm on Wednesdays. This extended care program is open full-time during the school year breaks from 7:00 am-6:00 pm. San Miguel Extended Child Care is approved to occupy classrooms #AS1, #AS2, & #AS3 on the San Miguel Elementary school campus. During today’s visit, rooms #AS1 & #AS2 were in use and toured during today's inspection. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children located on high shelves out of reach of children. facility representative stated there are no poisons in the facility, and none were observed during this inspection. LPA observed 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 indoors and outdoors by use of individual water bottles or disposable cups filled from the sink or water pitcher. Site Supervisor stated the children use the campus bathrooms. The center’s isolation area for any child who becomes ill while in care is located in the corner of AS2's class room.

Continued on LIC 809-C

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: SAN MIGUEL EXTENDED CHILD CARE	FACILITY NUMBER: 490111249
	VISIT DATE: 12/21/2023

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LPA observed 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. Menus are posted the #AS2 classroom. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. LPA observed the playground equipment and surface areas were in safe condition.

There is soft material cushioning underneath climbing structure to absorb falls. There were no bodies of water observed on the site. Facility representative stated no weapons are stored on site, and none were observed.

During today's inspection, staffing ratios were being met, a total of 45 children were being supervised by 5 staff. The facility was operating within the licensed capacity and ratio requirements.

At 1:46pm, 5 children’s records were reviewed and contained complete and current information as required.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Sonja Kaluahine.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian Phouthavong	TELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

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