Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125402275
Report Date: 10/24/2017
Date Signed: 10/26/2017 04:16:26 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:SALMONBERRY PRESCHOOLFACILITY NUMBER:
125402275
ADMINISTRATOR:NUNLEY-MONAHAN, KATHLEENFACILITY TYPE:
850
ADDRESS:300 TRINITY STREETTELEPHONE:
(707) 677-0477
CITY:TRINIDADSTATE: CAZIP CODE:
95570
CAPACITY:30CENSUS: 19DATE:
10/24/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH: Kathleen, NunleyTIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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. This program is operated by North Coast Children’s Services and is a Title 5 funded program located in room 7 on the the grounds of Trinidad Elementary School.

Operating hours are 9:00 am to 12:30pm Mon-Fri. 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 the janitor supply closet. The facility was free of flies, insects and rodents. 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. There is a shared bathroom waiver and the children are escorted. A current menu was posted. Food prep areas are clean. Food is properly stored and refrigerated as needed. They prepare and serve breakfast and lunch. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment sufficient to absorb falls. There were no bodies of water observed. The Director, Kathleen, Nunley 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.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: SALMONBERRY PRESCHOOL
FACILITY NUMBER: 125402275
VISIT DATE: 10/24/2017
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The facility was operating within the licensed capacity. At least one staff member present possessed current CPR and First Aid certifications. Children’s records were reviewed and contained identification forms with authorized representative information. Staff records were reviewed and contained documentation of education and training, as required. This facility is not providing Incidental Medical Services – 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
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2