493000369-9-30-2024-01-CC-ASTR-D9M23S-20240930170249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493000369
Report Date: 09/30/2024
Date Signed: 09/30/2024 05:02:57 PM

Document Has Been Signed on 09/30/2024 05:02 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
SANTA ROSA CC RO, 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	CENSUS: 25	DATE:	09/30/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Michelle Dominguez		TIME COMPLETED:	05:00 PM

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An Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. LPA met with Facility Representative and Director, Michelle Dominguez (D1). Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

This program is operated by Extended Child Care, a nonprofit agency. D1 stated that she has copies of the children's files and will notify the main office that LPA has arrived to review staff files which 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 am- 6:00 pm after school on Wednesdays, 1:00pm - 6:00pm Monday- Tuesday and Thursday-Friday, operating August to early June. During the summer months, early June to mid-August, and any non-school day the operating hours are 7:00 a.m. - 6:00 p.m, Monday - Friday. 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. The facility uses a digital sign in/out called Hubbe. 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 indoors by use of individual water cups and a water dispenser and outdoors by way of the school drinking fountain or individual water bottles. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill is located in the quiet corner, where a child is isolated from other children, until picked. Masks are made available to ill children.

Continued on LIC 809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

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

FACILITY NAME: R.L. STEVENS EXTENDED CHILD CARE	FACILITY NUMBER: 493000369
	VISIT DATE: 09/30/2024

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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 on the bulletin in 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 25 children were being supervised by D1 and 3 staff (S1-S3). The facility was operating within the licensed capacity and ratio requirements. At least one staff member present during the visit possessed current CPR and First Aid certifications, D1's certificate expires 02/2025. Five children’s records were reviewed and contained complete and current information as required. Four staff files were reviewed and contained all records as required.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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

Continue on LIC809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

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

FACILITY NAME: R.L. STEVENS EXTENDED CHILD CARE	FACILITY NUMBER: 493000369
	VISIT DATE: 09/30/2024

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Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

A notice of site visit was given to facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

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

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

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC809 (FAS) - (06/04)

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