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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 511374283
Report Date: 09/07/2022
Date Signed: 09/07/2022 12:22:32 PM

Document Has Been Signed on 09/07/2022 12:22 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:KING AVENUE STATE PRESCHOOLFACILITY NUMBER:
511374283
ADMINISTRATOR:CHAVEZ, MARIA CARMENFACILITY TYPE:
850
ADDRESS:630 KING AVENUETELEPHONE:
(530) 822-5019
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 19DATE:
09/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Carmen Chavez, DirectorTIME COMPLETED:
12:30 PM
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On 9/7/2022 at 8:45 AM, an annual inspection was made to the facility by Licensing Program Analyst (LPA), J. Helton. Upon arrival, the class was preparing and waiting for a planned fire drill. The fire drill began at 9:05 AM until about 9:30 AM. This program is operated by Yuba City Unified School District. and a Title 5 funded program. Operation hours are 8:00 AM-11:00 AM and 12:30 PM-3:30 PM, Monday–Friday. The facility was toured at 9:00 AM inside and outside and the floor and yard plan submitted by the licensee were verified. Facility operates in modular P6. The Director and 2 Aides were supervising 19 children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises. The playground equipment is clean, safe and appropriate. There is bark cushioning underneath climbing structures and play equipment to absorb falls. 12 children's records were reviewed from 9:38 AM- 9:52 AM. 5 staff records were reviewed at 11:18 AM - 11:45 AM at a separate location, all files were complete.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Continued on LIC 809C

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jackie Helton
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: KING AVENUE STATE PRESCHOOL
FACILITY NUMBER: 511374283
VISIT DATE: 09/07/2022
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This facility provides Incidental Medical Services – IMS, However, currently has no children with IMS requirement. 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: http://www.ada.gov/childqanda.htm

There were no deficiencies cited during today’s inspection

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director Carmen Chavez.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jackie Helton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC809 (FAS) - (06/04)
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