525405509-11-19-2019-13-CC-CWIT-BJ3SRG-20191119130620

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525405509
Report Date: 11/19/2019
Date Signed: 11/19/2019 01:06:29 PM

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:	JACKSON HEIGHTS STATE PRESCHOOL		FACILITY NUMBER:	525405509
ADMINISTRATOR:	ASCHERIN, MACHELLE		FACILITY TYPE:	850
ADDRESS:	225 JACKSON STREEET		TELEPHONE:	(530) 529-6741
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	24	CENSUS: 19	DATE:	11/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Kristin Briggs Site Supervisor		TIME COMPLETED:	01:15 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	An inspection was made to the facility by Licensing Program Analyst Wisehart. The facility file was reviewed prior to this visit. This is a Title 5 program operated by Tehama County Department of Education and is housed on the Jackson Heights School grounds. Head Start operates a separate program in the neighboring temporary building. Operating hours are 8:15am - 11:15am and 12:30pm - 3:30 pm, Mon-Fri. The facility is closed in the summer. The facility was toured inside and outside and the floor and yard plan were verified. The items which could pose a danger to children (detergents, cleaning compounds and medications) were inaccessible to children. Poisons are locked in the janitor closet in the staff restroom. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces appeared clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children's bathrooms appeared in safe and sanitary condition. A current menu was posted on parent board. Breakfast and lunch are provided. Food is prepared by the elementary school. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment sufficient to absorb falls. There were no bodies of water observed. The site supervisor stated no weapons are stored on site and none were observed. During today's inspection, Title 5 staffing ratios were being met and children were being properly supervised. The facility was operating within the licensed capacity. At least one staff (S1 & S2) member present possessed current CPR (6/20)and First Aid (expires 8/20) certifications .

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: JACKSON HEIGHTS STATE PRESCHOOL	FACILITY NUMBER: 525405509
	VISIT DATE: 11/19/2019

NARRATIVE

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The LPA reviewed 20 out of 20 children’s records at 12:39 pm and they contained identification forms with authorized representative information. LPA reviewed 3 out of 3 Staff records at 12:45 pm and they contained the required immunization's. This facility is providing Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 brochure, were reviewed and discussed with the site supervisor. 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 Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019

LIC809 (FAS) - (06/04)

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