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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475407949
Report Date: 12/03/2021
Date Signed: 12/03/2021 12:51:37 PM

Document Has Been Signed on 12/03/2021 12:51 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:SISKIYOU CREDIT UNION CHILDCARE CENTERFACILITY NUMBER:
475407949
ADMINISTRATOR:EMILY STONEFACILITY TYPE:
830
ADDRESS:841 FOURTH STREETTELEPHONE:
(530) 643-6282
CITY:YREKASTATE: CAZIP CODE:
96097
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 4DATE:
12/03/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Emily StoneTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) N. Cunningham met with Emily Stone to conduct a prelicensing inspection for a Child Care Center (CCC) application requesting a capacity of five infants and five toddlers. The application was received by CCLD on July 1, 2021.

LPA Cunningham inspected and measured the interior of the building and the exterior outdoor play area. There are two classrooms and a proposed nap room. The director is currently reviewing options on how the center will be set up. There is a kitchen, separate teacher restroom and an office.

The outdoor play will be at the West end of the building and is currently under construction. The construction plan indicates there will be 750 square feet of outdoor space which is sufficient for ten children.

The following items will need to be verified for licensure:

1. Update LIC200A with correct age of children in care
2. Board Resolution – The board resolution that was submitted does not indicate that Emily Stone is authorized to file the application on behalf of the corporation.
3. Monthly Operating Statement (LIC401)
4. Indoor Facility Sketch- add number of toilets and sinks, specify napping area and clearly show dimensions
5. Outdoor Facility Sketch – show dimensions of play area, buildings, fences, etc.
6. Articles of Incorporation – needs to include Secretary of State seal, constitution and by-laws
7. Director Qualifications – please submit an exemption request since the director is planning on enrolling in 3 administration units in Spring 2022.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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: SISKIYOU CREDIT UNION CHILDCARE CENTER
FACILITY NUMBER: 475407949
VISIT DATE: 12/03/2021
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8. Proof of negative TB test for director
9. Job Description – include one job description for each position listed on personnel report (including the director), minimum qualifications must include the number of units required and length of experience
10. Personnel Policies – add employee’s rights and background clearances required (DOJ, FBI, Child Abuse Central Index)
11. In-Service Training Plan: add the topics of nutrition and availability of community services and resources
12. Admission Agreement – add rights of licensing agency and written parent permission to attend toddler option
13. List of Furniture/Equipment – Please provide additional equipment or explain where the other infants will eat and nap.
14. Obtain furniture, crib mattress, and high chairs
15. LPA must receive a copy of the fire inspection from the Yreka County Fire Inspector. The inspector conducted the fire inspection and told Ms. Stone that the fire clearance has been approved but LPA awaits the approved Std850 form from the inspector.
16. Obtain and install carbon monoxide detector
17. Clean kitchen fridge
18. Secure mini blind cords so they are inaccessible
19. Classroom A – make closet inaccessible

LPA Cunningham will return after the director sets up the indoor area for ten infants/toddlers and after the outdoor play area is completed to conduct the final prelicensing inspection.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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