Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125402275
Report Date: 11/06/2018
Date Signed: 11/06/2018 10:02:50 AM

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:20CENSUS: 14DATE:
11/06/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Kathleen NunleyTIME COMPLETED:
10:05 AM
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An inspection was made to the facility by Licensing Program Analysts (LPAs), Chris Krogstad and Mikah Martinez. 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 a Title 5 funded State Preschool operated by North Coast Children's Services on the Trinidad Elementary School grounds in room #7.

The facility’s operating hours are 9am-12:30pm, Monday - Friday. 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 stored with the school janitor. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors by water dispenser that is moved from the classroom to the outside area. The children's bathrooms are in safe and sanitary condition. A current menu was posted near the sign in area of the classroom. Food prep areas are clean. Food is properly stored and refrigerated as needed. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas are in safe condition. There is rubber cushioning underneath climbing structures and/or play equipment to absorb falls. 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 14 children were being supervised by the Director and two aides. The facility was operating within the licensed capacity. At least one staff member present during the visit (S2) possessed current CPR and First Aid certifications. Ten children’s records were reviewed at 9:40am and contained identification forms with authorized representative information. Five staff records were reviewed at 9:25am and contained proof of required mandated reporter training and immunization's
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Christen KrogstadTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2018
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: SALMONBERRY PRESCHOOL
FACILITY NUMBER: 125402275
VISIT DATE: 11/06/2018
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This facility is not providing Incidental Medical Services (IMS). The Department’s Incidental Medical Services (IMS) policy was discussed with the Director. 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: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Christen KrogstadTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2018
LIC809 (FAS) - (06/04)
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