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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407235
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:09:57 PM

Document Has Been Signed on 11/16/2023 01:09 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:BUTTERFLY BUNGALOWFACILITY NUMBER:
525407235
ADMINISTRATOR:WILLIAMS, TRISHAFACILITY TYPE:
850
ADDRESS:415 ANTELOPE BLVD., SUITE BTELEPHONE:
(530) 737-1018
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 0DATE:
11/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Tori PrestTIME COMPLETED:
01:00 PM
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A prelicensing inspection was conducted today at 11am by Licensing Program Analyst (LPA), J. Snow. LPA met with facility representative Tori Prest. The facility representative is requesting a change in the license from 15 preschool to 10 Toddler only.
The facility will operate Monday-Friday, 7:30am to 4:30pm. (Wed 7:30am-12:30pm) The facility has one children’s bathroom with 2 toilets and one sink. The staff bathroom is in the front building (Caterpillar Cottage) that shares a parking lot. The fire clearance for 10 toddlers was approved on November 1, 2023.

The indoor and outdoor activity spaces were toured, and the facility sketch was verified. The following areas will be off limits to children: the office and kitchen. These areas have been made inaccessible by means of half door. There is a kitchen to store/prepare meals. They prepare breakfast lunch snack onsite. Children will nap on cots in the classroom. The isolation area for sick children will be in the office. The changing table is located in the bathroom.
The outdoor play area is fully fenced. There has small slide for children to play on and adequate cushioning underneath. There is no pool, spa, pond, fountain, or any other body of water on the premises. There is safe and age appropriate furniture, toys, and play equipment available for children.
A capacity worksheet was completed during the visit. There is enough indoor space for 16 children and outdoor space for 27 children. There are 2 toilets and 1 sinks available for children. Based on the above, the maximum capacity of the facility could be 15.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: BUTTERFLY BUNGALOW
FACILITY NUMBER: 525407235
VISIT DATE: 11/16/2023
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Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (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.

LPA reviewed with facility representative the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: BUTTERFLY BUNGALOW
FACILITY NUMBER: 525407235
VISIT DATE: 11/16/2023
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The facility representative was informed of the MyChildCarePlan.org site, 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.

Exit interview conducted and report was reviewed with the facility representative Tori Prest.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.


The following items need to be completed prior to the granting the license:

1 Birds eye sketch of facility showing parking lot, buildings & yard
2. Managerial approval
3. Board Resolution Designating the director
4. Designation of authority authorizing Tori Prest
5. director; PHP class enrolled. Must send proof of completion within a week of completion on 5/24/24.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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