Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490111334
Report Date: 04/07/2016
Date Signed 04/07/2016 05:58:00 PM

COMPREHENSIVE INSPECTION
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:MARK WEST EXTENDED CHILD CAREFACILITY NUMBER:
490111334
ADMINISTRATOR:LINDA CREEKMOREFACILITY TYPE:
840
ADDRESS:4600 LAVELLE ROADTELEPHONE:
(707) 526-4066
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:126CENSUS: 45DATE:
04/07/2016
TYPE OF VISIT:Required - 5 YearUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Linda Creekmore, DirectorTIME COMPLETED:
05:15 PM
NARRATIVE
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LPA Nicolette Cunningham conducted an unannounced visit inspection and met with Linda Creekmore, Director. Present were 45 children, 4 teachers, and the director. Staff ratio and capacity in compliance. Staff are fingerprint cleared through Extended Child Care. All children were always under visual supervision. LPA inspected three classrooms, bathrooms and outside play yard.

No bodies of water, weapons, firearms were on site.
Disinfectants, toxins and other hazards were inaccessible to children, in locked cabinets or up high.
Materials and surfaces appear safe and toxic free.
IMS plan of operations discussed.
All toilets and hand washing facilities appeared safe and sanitary.
All floors appeared safe and clean.
Furniture and equipment appeared to be in good condition and safe.
All kitchen/food prep areas appeared clean and free of rodents.
Solid waste storage containers have lids.
Uncontaminated drinking water available inside and outside
All food and beverages stored in fridges of 45' or less.
Playground equipment appeared in good and safe condition.
Outdoor activity space surface appeared safe and free of hazards.
Staff had current CPR/First Aid.
Children's records reviewed for consent of medical treatment and were complete..
Sign in/out sheets had full parent/guardian signatures.
Menu was posted

See 809D for citation. Appeal rights provided.

Notice of Site Visit posted
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: 707-588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2016
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: MARK WEST EXTENDED CHILD CARE
FACILITY NUMBER: 490111334
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2016
Section Cited
101238(g)(1)
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(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. (1) Storage areas for poisons shall be locked. -Today, ant traps were stored in a cabinet with a tot lock. The poison was not under key or combination lock. The poison was inaccessible to children.
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Director will take the poison off site at 6:00 pm. Director will e-mail LPA confirmation.

nicolette.cunningham@dss.ca.gov
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: 707-588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2016
LIC809 (FAS) - (06/04)
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