045407962-9-28-2021-13-CC-JSNW-C7AUVA-20210928155450

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 045407962
Report Date: 09/28/2021
Date Signed: 09/28/2021 03:54:59 PM

Document Has Been Signed on 09/28/2021 03:54 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	LITTLE PINES PRESCHOOL		FACILITY NUMBER:	045407962
ADMINISTRATOR:	TELLEZ, SHELLY		FACILITY TYPE:	850
ADDRESS:	2022 FRANKLIN STREET		TELEPHONE:	(530) 965-2202
CITY:	CHICO	STATE: CA	ZIP CODE:	95928
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/28/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Shelly Tellez and (Andi) Andrea Drane		TIME COMPLETED:	04:15 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	The facility pre-licensing inspection was conducted by Licensing Program Analyst (LPA) Snow. The applicant has applied for a capacity of 24 preschool age children. The facility was toured inside and outside. The center will operate from 7 am - 5:30 pm, M-F. The preschool facility consists of 1 classroom(s) serving ages 2 to 5 years old. The fire clearance was approved.. The indoor & outdoor capacity only measured for a capacity of 23 children. Required postings (Parents Personal Rights, Emergency Disaster Plan, Earthquake Preparedness Checklist, Menu, etc.) listed on Form LIC 311A are posted. The applicant was advised that all staff are required to have a criminal background clearance on file with Community Care Licensing. The applicant is aware of the immediate $100 per day civil penalty for anyone providing care or supervision without a criminal record clearance. This is a combination infant preschool facility. Children will use the fenced outdoor play area. Sign-In/Out procedure were reviewed and are done electronically. The applicant/director understands that if a manual Sign-In/Out procedure is used; full legal signatures are required. Cubbies are available for children to use. There are pull alarms, and there is a working carbon monoxide detector and charged fire extinguisher in the facility rated at least the 2A10BC. All Exits are marked. There is one bathroom with 2 toilets and 2 sinks. There is a staff bathroom, which are separate. Water is provided inside and outside via drinking fountains. The isolation area for a sick child will be established in staff office and a mat will be provided. The facility has sufficient cots available for children.snacks will be provided at the program. Continued

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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: LITTLE PINES PRESCHOOL	FACILITY NUMBER: 045407962
	VISIT DATE: 09/28/2021

NARRATIVE

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Continued from LIC 809)

The food is properly stored. Age appropriate toys and activities are available for children. There is grass cushion material outside under the boat /play structures sufficient to absorb falls. There are trees present to provide shade in the play yard. There are no bodies of water located on the property and none are to be added without prior notification and approval of the licensing agency. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes 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 report, as well as the Guide to Safe Sleep Practices brochure, Lead Exposure Testing and COIVD Guidance were reviewed and discussed with the applicant/director. All licensing reports are public information and must be made available upon request for at least three years.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

The facility is ready for licensure for 23 children effective September 29, 2021

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

LIC809 (FAS) - (06/04)

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