Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121303248
Report Date: 04/11/2019
Date Signed: 04/11/2019 02:26:40 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:
04/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Pollyanna RamosTIME COMPLETED:
02:30 PM
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An inspection was conducted at the facility by Licensing Program Analysts (LPA), Kiriko Lynch and Patricia Pacheco. The facility file was reviewed prior to this inspection. A review of the personnel report on 04/08/19, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This program is operated on the Humboldt State University Campus.

The facility’s operating hours are 8:50 am - 5:00 pm, Monday – Thursday and Friday 8:50 am - 12:00 pm and follows the college sessions. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Poisons are locked in the janitorial closet. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors, via pitcher and cups, and outdoors via water fountain. The children’s bathrooms were in safe and sanitary condition. A current menu for snacks was posted near the sign in sheets. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. 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. The site supervisor stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were 15 children were being supervised by the site supervisor, 1 teacher and 4 student aides. The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2019
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: 04/11/2019
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certifications. Ten children’s records were reviewed at 1:50 pm, and contained identification forms with authorized representative information, as well as medical assessments. Four staff records were reviewed at 2:05 pm, and contained health screening forms. The sign in/out procedure was reviewed and in compliance. This facility is not currently providing Incidental Medical Services (IMS) to children. The Department’s IMS policy was discussed with the site supervisor. 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 was reviewed and discussed with the site supervisor. 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.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2019
LIC809 (FAS) - (06/04)
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