Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009438
Report Date: 06/20/2018
Date Signed: 06/20/2018 12:17:07 PM

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:LITTLE BACKPACKS PRESCHOOLFACILITY NUMBER:
283009438
ADMINISTRATOR:KEENER, KATIEFACILITY TYPE:
850
ADDRESS:995 ADAMS STREETTELEPHONE:
(707) 963-4705
CITY:ST. HELENASTATE: CAZIP CODE:
94574
CAPACITY:50CENSUS: 24DATE:
06/20/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Katie KeenerTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA) Kevin O'Connell & Mary Trinh toured the facility with licensee on 6/20/18 at 11:10am. Record reviews were conducted with director.
The facility file was reviewed prior to the inspection.
The facility operates; Monday - Friday; 7:30am - 05:30pm. The classrooms appeared clean and organized. This building houses this preschool license and infant license 283009437. This preschool license is licensed for 50 children. There are 24 children with 3 teachers today. The preschool consists of three separate classrooms and fenced play yards. LPAs inspected the classroom and playground. Fire extinguishers were charged and at least one carbon monoxide detector was functioning. Today staffing ratios were being met. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Disinfectants and cleaning solutions are inaccessible. The toys, floors, desks, and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's bathrooms appeared in safe and sanitary operating condition. The playground was completely fenced and the equipment appeared in safe condition. There were wood chips under the climbing structures/ play equipment to absorb falls. Trash cans used for solid waste have tight fitting lids. Kitchen areas appear clean. Morning & afternoon snacks are served. Menus were posted. Floors and other surfaces appear clean. Furnishings, equipment, toys and activities are age and developmentally appropriate, found in safe condition. The sign in/ out log (electronic) was in compliance. Children's admission agreements werer available for review and were checked. Incidental Medical Services (IMS) policy was discussed. No IMS is being provided at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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: http://www.ada.gov/childqanda.htm
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2018
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LITTLE BACKPACKS PRESCHOOL
FACILITY NUMBER: 283009438
VISIT DATE: 06/20/2018
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All licensing reports are public information and must be made available upon request for at least three years.
Director states that there are no pools, spas, hot tubs, fish ponds or bodies of water and none were observed.
Director states that there are no guns or dangerous weapons and none were observed.

Child Abuse Mandated Reporter Training information (free) was given and certificates were requested. All were complete.
Personnel Immunization records for Measles, Pertussis, Influenza were reviewed.


Child Care Providers Guide to Safe Sleep was given
English: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https://www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
This report was read and discussed with the supervisor.
There were no deficiencies cited today.
Notice of Site Visit shall be posted for 30 days from today's visit.
Failure to keep this notice posted for 30 days may result in a civil penalty of $100.
The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2018
LIC809 (FAS) - (06/04)
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