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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500035
Report Date: 08/30/2021
Date Signed: 08/30/2021 01:42:49 PM

Document Has Been Signed on 08/30/2021 01:42 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:GIBSON STATE PRESCHOOLFACILITY NUMBER:
574500035
ADMINISTRATOR:GABRIELA GARCIAFACILITY TYPE:
850
ADDRESS:312 GIBSON RDTELEPHONE:
(530) 406-5951
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
08/30/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Site Supervisor, Gabriela GarciaTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Chayntel Hunter met with Site Supervisor, Gabriela Garcia and Director of Early Childhood Education, Maria Lewis for the purpose of an unannounced Annual inspection. LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. Facility days and hours of operation are Monday-Friday from 8:00 AM to 3:30 PM. Facility provides breakfast, lunch and snack which is supplied by the school district. There were nine children present during today's inspection.

LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured.

LPA reviewed the electronic sign in/out book and observed that the children are properly signed in. LPA reviewed children’s and staff files. All staff present during today's inspection have a fingerprint clearance. LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid (exp. 10/2022).

Report continues on 809-C.

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: GIBSON STATE PRESCHOOL
FACILITY NUMBER: 574500035
VISIT DATE: 08/30/2021
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LPA checked that annual fees are current.

This provider is not currently providing Incidental Medical Services (IMS) services to children in care, but facility has an IMS plan in place. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 facility evaluation report was reviewed and discussed with the Site Supervisor. An exit interview was conducted. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. The Site Supervisor was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

In the areas that were evaluated, no deficiencies were cited during the inspection.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC809 (FAS) - (06/04)
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