Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121303248
Report Date: 05/05/2016
Date Signed: 05/05/2016 11:08:43 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CHILD DEVELOPMENT LABORATORYFACILITY NUMBER:
121303248
ADMINISTRATOR:MOONEY, JILLIANFACILITY TYPE:
850
ADDRESS:1 HARPST STREETTELEPHONE:
(707) 826-3475
CITY:ARCATASTATE: CAZIP CODE:
95521
CAPACITY:26CENSUS: 20DATE:
05/05/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Jillian MooneyTIME COMPLETED:
10:24 AM
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(2) LPA DeAnna Sanders conducted a random annual to this Lab Preschool at Humboldt State University. The facility was toured and records were reviewed. There are no water hazards or fire arms on site per the Director and none were observed by the LPA. Disinfectants and other cleaning solutions were observed to be out of reach of children. There is locking storage for poisons. Medications are out of reach. The furnishings and equipment are free of sharp surfaces. The play area is in adequate condition. The surfaces have adequate paint surfaces. No immediate hazards were observed. There is one sink that has numerous cracks. This needs to be repaired or replaced. Other toilets and sinks are in good condition and operational. The floors are clean. No sign of insects or vermin was observed. The kitchen is clean and the menu is posted. There is covered trash for garbage. There is drinking water inside and out. No toxic surfaces were observed. The LPA was allowed to enter and inspect the facility. Adult staff present have criminal record clearances. The facility is within capacity and ratio today. The Director remains the same and has a Program Director Permit. Children are supervised. Children have adequate identifying information. Teaching staff have transcripts. Interactions between children and staff were observed to be appropriate. One person has first aid and cpr. No deficiencies are cited.
SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5034
LICENSING EVALUATOR NAME: Deanna SandersTELEPHONE: (707) 826-9961
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2016
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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