Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009251
Report Date: 08/15/2016
Date Signed: 08/16/2016 08:11:07 AM

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:STARS PRESCHOOL - TWO ROCKFACILITY NUMBER:
493009251
ADMINISTRATOR:SMITH, MALLORYFACILITY TYPE:
850
ADDRESS:5001 SPRING HILL ROADTELEPHONE:
(707) 762-6617
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:24CENSUS: 0DATE:
08/15/2016
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Jynx LopezTIME COMPLETED:
03:30 PM
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
A prelicensing visit was conducted today by LPA M.Augustin. The preschool is situated on the grounds of The Two Rock Elementary School. LPA met with Applicant and the facility designated Director. The Preschool program's business hours will be Mon-Fri 7:30am to 5:30pm. The facility was still undergoing construction inside the classroom and on the playground. The classroom is sectioned into Art, Math/Manipulative, Dramatic Play and Reading. Electrical outlets have safety covers. There are 2 bathrooms for the children to use. There are 8 tables and 27 chairs available. There are no bodies of water on the premise. Applicant stated that poisons are not kept on site. The Applicant stated that there are no fire arms on the premise and none were observed by LPA. There are 2 functional toilets and 2 operational sinks inside the classroom. The water at the sinks used by children is below 120 degrees. Toilet paper, paper towels and hand soap are available to meet the children's needs. The classroom has a sink with only cold water delivery. Drinking water is readily available both inside and out. Children have access to a drinking fountain inside the classroom. The applicant stated that an igloo will be used to store water outdoor and children will use disposable paper cups to drink water outdoors. Classrooms have furniture and equipment that is age appropriate. Heating, lighting, and ventilation are adequate. There is adequate storage for the children's belongings. There are 24 mats and cots for children to nap. There is 35 square feet of indoor space per child based on the total requested capacity of 24. The Art storage area will be used as the Isolation Area. The kitchen is inside the Director’s office. Food preparation area is inaccessible to children. The center will provide 2 snacks and a lunch for children. Cleaning supplies are inaccessible to children and are stored separately from food. The outdoor play area was inspected. There is more than 75 square feet per child. Shade is provided by overhang for shade. Fencing is more than 4 feet high around the perimeter of the playground. The playground is still under construction and Applicant stated that playground will be ready by August 17, 2016. The playground has a storage unit that will be used to the store toys. The Applicant stated that the storage unit will remain locked. Sandbox is free of hazardous materials and will be covered. All required posting are posted in a prominent place near the entrance. There is a sample menu posted near the entrance.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2016
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: STARS PRESCHOOL - TWO ROCK
FACILITY NUMBER: 493009251
VISIT DATE: 08/15/2016
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
Bedding and mats are stored properly. There is a working telephone on the premises. There is a working carbon monoxide detector in the Director’s office. The smoke detector is hardwired in. First aid supplies are kept in the classroom, above the cubbies and above the sink near the children’s restroom. There is at least 1 person with a current pediatric CPR/First Aid card and Preventative Health and Safety . The Preschool will be providing Incidental Medical Services. Children’s medication will be stored in the kitchen cabinet, above the refrigerator. Updated information was given.
The following is needed for a license:
The Director and the Assistant Director’s current LIC 508 and LIC 9182.
A lockbox for IMS
A Sandbox cover
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2016
LIC809 (FAS) - (06/04)
Page: 2 of 2