Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121303248
Report Date: 04/25/2018
Date Signed: 04/25/2018 02:45:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
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: 15DATE:
04/25/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jillian MooneyTIME COMPLETED:
03:00 PM
NARRATIVE
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An inspection was made to the facility by LPA, Snow. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility is located on the grounds of the Humboldt State University.

Operating hours are 8:50 am – 5:00 pm Mon-Fri they follow the campus schedule (closed from approximately May through the end of August, Winter/Spring Break and other school holidays). The facility was toured inside and outside and the floor and yard plan were verified. The items which could pose a danger to children (detergents, cleaning compounds and medications) were inaccessible to children. Poisons are locked in kitchen cabinet. The toys, floors, desks and other equipment and surfaces appeared clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children's bathrooms appeared in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. AM & PM snacks are provided. Garbage cans containing solid waste have tight fitting lids. There is a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There are currently no climbing structures. There were no bodies of water observed. The Director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and children were being properly supervised. The facility was operating within the licensed capacity. At least one staff member present possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2018
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CHILD DEVELOPMENT LABORATORY
FACILITY NUMBER: 121303248
VISIT DATE: 04/25/2018
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Children’s records were reviewed and contained signed admission agreements. Staff records were reviewed and contained documentation of education and training, as required. This facility is providing Incidental Medical Services and will send an updated plan – IMS. Incidental Medical Services (IMS) policy was discussed. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, were reviewed and discussed with the Director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

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

Send the following within 30 days to update the facility file;
LIC 999 Yard and Floor Plan
LIC 309 Administrative Organization
IMS Plan (Incidental Medical Services)
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2018
LIC809 (FAS) - (06/04)
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