525406960-1-29-2020-13-CC-CWIT-BLANWD-20200129094919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525406960
Report Date: 01/29/2020
Date Signed: 01/29/2020 09:49:31 AM

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:	DOUGLAS STREET STATE PRESCHOOL		FACILITY NUMBER:	525406960
ADMINISTRATOR:	WEAVER, VIRGINIA		FACILITY TYPE:	850
ADDRESS:	1290 GARDEN AVENUE		TELEPHONE:	(530) 528-7319
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY:	20	CENSUS: 11	DATE:	01/29/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Lori Hagen		TIME COMPLETED:	09:30 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 inspection was made to the facility by Licensing Program Analyst, Wisehart. The facility file was reviewed prior to this visit. Criminal Background checks are a requirement of employment. This is a State Preschool program operated by Tehama County Department of Education, but is privately funded. Operating hours are 7:30am - 5:30pm, Monday-Friday, year round. 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. Poisons are locked in staff bathroom janitorial cabinet. 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 (cups) and outdoors (water bottles). The children's bathrooms are in safe and sanitary condition. A current menu was posted on parent board. 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. 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, staffing ratios were being met and 11 children were being supervised by 2 teachers/aides. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications (expires 6/2021).

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020

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: DOUGLAS STREET STATE PRESCHOOL	FACILITY NUMBER: 525406960
	VISIT DATE: 01/29/2020

NARRATIVE

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Eleven children’s records were reviewed at 8:25 am, and contained identification forms with authorized representative information. Two staff records were reviewed at 8:15 am, and contained documentation of education and training, as required. This facility is not providing Incidental Medical Services (IMS). The Department’s Incidental Medical Services (IMS) policy was discussed with the Licensee/Director. (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 brochure, Shaken Baby Syndrome and Effects of Lead Exposure Flyer and Provider Notice, 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: 01/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020

LIC809 (FAS) - (06/04)

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