493000369-9-7-2022-01-CC-ASTR-CJ2TZA-20220907151002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493000369
Report Date: 09/07/2022
Date Signed: 09/07/2022 03:10:13 PM

Document Has Been Signed on 09/07/2022 03:10 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	R.L. STEVENS EXTENDED CHILD CARE		FACILITY NUMBER:	493000369
ADMINISTRATOR:	JASON RIGGS		FACILITY TYPE:	840
ADDRESS:	2345 GIFFEN AVENUE		TELEPHONE:	(707) 579-6267
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95407
CAPACITY: 112	TOTAL ENROLLED CHILDREN: 30	CENSUS: 24	DATE:	09/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Michelle Dominguez		TIME COMPLETED:	03:22 PM

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A required one year inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. LPA met with Facility Representative and Director, Michelle Dominguez (D1). The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff have received criminal record and child abuse index clearances or exemptions. Facility representative, Michelle Dominguez was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This program is operated by Extended Child Care, a nonprofit agency. D1 stated that all children's files and staff files are stored off site at the Extended Child Care main office located at 1745 Copperhill Pkwy Ste. #5 Santa Rosa, CA 95403. This is a school-age license located on the campus of Robert L. Stevens Elementary School. The facility’s operating hours are 7:00 a.m. - 8:30 a.m. before school and 11:30 a.m.- 6:00 p.m. after school, Monday - Friday mid- August to early June. During the summer months, early June to mid-August, the operating hours are 7:00 a.m. - 6:00 p.m. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. The facility is currently occupying classroom #1 and #2. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children located in locked cupboards out of reach of children. D1 stated there are no poisons in the facility, and none were observed during this inspection. LPA observed 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 and outdoors with a self-serve jug of water and individually labelled reusable water cups. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located in the office.

Continued on LIC 809-C.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: R.L. STEVENS EXTENDED CHILD CARE	FACILITY NUMBER: 493000369
	VISIT DATE: 09/07/2022

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LPA observed food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. Menus are posted in the front window of the classroom and on the refrigerator in the kitchen. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. LPA observed the playground equipment and surface areas were 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 on the site. D1 stated no weapons are stored on site, and none were observed.

During today's inspection, staffing ratios were being met, a total of 24 children were being supervised by D1 and 2 staff, S1 and S2. The facility was operating within the licensed capacity and ratio requirements. LPA could not verify that at least one staff member present during the visit possessed current CPR and First Aid certifications because the files are stored at the main office listed above. LPA will visit the main office on a later date to verify CPR and first Aid certifications. LPA will also review children's files and files for staff D1, S1 and S2 while visiting the main office and return to the facility to complete the inspection after the file review is complete.

This facility provides Incidental Medical Services – IMS, however D1 stated that no children currently enrolled have IMS needs and no medication is currently stored at the facility. 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: http://www.ada.gov/childqanda.htm

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview conducted and report was reviewed with Director, Michelle Dominguez.

Continue on LIC809-C (2)

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: R.L. STEVENS EXTENDED CHILD CARE	FACILITY NUMBER: 493000369
	VISIT DATE: 09/07/2022

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC809 (FAS) - (06/04)

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