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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573600620
Report Date: 12/23/2019
Date Signed: 12/23/2019 11:03:01 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:GIBSON SCHOOL-AGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
573600620
ADMINISTRATOR:OSTERHOUDT, ASHLEYFACILITY TYPE:
840
ADDRESS:312 GIBSON ROADTELEPHONE:
(530) 666-4822
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:74CENSUS: 17DATE:
12/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Site Supervisor, Ashley OsterhoudtTIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPAs) Chayntel Hunter and Christopher Jackson met with Site Supervisor, Ashley Osterhoudt for the purpose of an unannounced Annual/Random inspection. LPAs observed 17 school aged children supervised by 4 staff in Classrooms #1 and #2. The Site Supervisor stated school aged children arrive at the facility at 2:00 PM on school days. Facility days and hours of operation are Mon, Tues, Thurs and Fri from 7:00 AM to 8:30 AM and from 2:00 PM to 6:00 PM, or Wednesday from 7:00 AM to 8:30 AM and from 1:30 PM to 6:00 PM. Facility is open year round and during school breaks the facility is open from 7 AM to 6 PM. Facility provides breakfast and a PM "super" snack on school days. During breaks the facility provides breakfast, lunch and a PM "Super" snack.

LPAs toured the facility inside and out. LPAs observed that hazardous items (disinfectants, cleaning solutions, etc.) were inaccessible to children in care. LPAs observed the following items during today's inspection: care and supervision of children, staffing ratios, first aid supplies, furniture, equipment, and access to drinking water. LPAs observed all required forms to be posted. Outdoor play area was toured, the play structure appeared to be in good repair, there is sufficient cushioning (wood chips) under the play structure.

LPAs reviewed the sign in/out book and observed that the children are properly signed in/out. All staff present during today's inspection have a fingerprint clearance and are associated to Sunset Ranch Center #313620604. LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. All staff members present today has a current AB1207 mandated reporter training certificate. The Site Supervisor was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

Report continues on 809-C.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: GIBSON SCHOOL-AGE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 573600620
VISIT DATE: 12/23/2019
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LPA verified the annual fees are current.

This facility provides Incidental Medical Services (IMS). LPAs reviewed storage of medications and equipment/supplies, and reviewed children’s personnel, and administrative records.



When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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.

This facility evaluation report was reviewed and discussed with the Site Supervisor. An exit interview was conducted. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. The Site Supervisor was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

In the areas that were evaluated, no deficiencies were cited during the inspection.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019
LIC809 (FAS) - (06/04)
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