573622022-8-16-2019-53-CC-CJAN-BF4SMT-20190816140027

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573622022
Report Date: 08/16/2019
Date Signed: 08/16/2019 02:00:37 PM

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:	YCOE PLAINFIELD		FACILITY NUMBER:	573622022
ADMINISTRATOR:	TAM, JACQUELINE		FACILITY TYPE:	850
ADDRESS:	20450 ROAD 97		TELEPHONE:	(530) 662-9301
CITY:	WOODLAND	STATE: CA	ZIP CODE:	95695
CAPACITY:	24	CENSUS: 0	DATE:	08/16/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kathleen Glassman		TIME COMPLETED:	02:05 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	Licensing Program Analysts (LPAs) Christopher Jackson, Chayntel Hunter and Charlotte Baney conducted a site inspection for the purpose of a Room Change inspection. LPAs met with Kathleen Glassman, the Information Specialist for YCOE. The program is moving from room C-5 to Room P-5 on the campus of Plainfield Elementary. LPAs observed one toilet and two sinks in the classroom. Information Specialist stated the children in care will also utilize the restrooms in the prior classroom of C-5. LPAs observed two additional toilets and three additional sinks in the C-5 classroom. LPAs discussed 100% supervision when transitioning any children into the adjacent classroom, restroom. The facility is requesting the capacity of 24 children. LPAs observed that the facility has the following documents posted on the parent’s board: Parents Rights, Personal Rights, Car Seat Law, Emergency Disaster Plan, and Earthquake Checklist. LPAs observed smoke and Carbon monoxide detectors and a fire extinguisher that all meet title 22 regulations. The facility plans to operate Monday thru Friday 7:30 AM to 3:45 PM. The information specialist stated the program will operate in conjunction with the Woodland Joint Unified school district traditional school schedule. The Information Specialist stated that the facility provides a breakfast, lunch and a PM snack. Lunches in the program are provided by the Woodland Joint Unified School District and delivered to the facility on a daily basis. INDOOR ACTIVITY SPACE: The indoor space is one classroom. LPAs observed the facility has a total of three toilets and five sinks. This is sufficient to meet the needs of the requested 24 children. The classroom is equipped with child size furnishings. The Information Specialist stated the program does offer a nap session, LPAs observed nap mats to be utilized by children care. The classrooms contains a total measurement of 847.015 square feet which is enough to accommodate the licensed capacity request of 24 Preschool Age children. Report Continues on 809-C

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

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: YCOE PLAINFIELD	FACILITY NUMBER: 573622022
	VISIT DATE: 08/16/2019

NARRATIVE

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OUTDOOR ACTIVITY SPACE:
The outdoor play area is fenced and is equipped with children's outdoor play equipment. The outdoor activity space was measured. Measurements for outdoor area were 2,470 square feet which will accommodate the licensed capacity request of 24 Preschool age children. Information Specialist stated that water jugs will be utilized for children when outside. There is structure in the play yard to be utilized by the preschool children.

LPAs discussed IMS. The facility provides Incidental Medical Services- IMS. LPAs 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 Family Child Care Homes Section 102417. 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

Effective today, 08/16/19, LPAs are granting a license. An exit interview was conducted in which the report was reviewed and discussed with Kathleen Glassman. Notice of Site visit and appeal rights were printed and provided during today's inspection.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

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