Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525405507
Report Date: 04/28/2017
Date Signed 04/28/2017 02:23:27 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:OLIVE VIEW STATE PRESCHOOLFACILITY NUMBER:
525405507
ADMINISTRATOR:BROWN, SHELLYFACILITY TYPE:
850
ADDRESS:521 ALMOND STREETTELEPHONE:
(530) 524-5319
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY:24CENSUS: 20DATE:
04/28/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Angie LorimorTIME COMPLETED:
02:30 PM
NARRATIVE
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(1) A visit was made to the facility by LPA, Chris Archer. The facility file was reviewed prior to this visit. This is a Title 5 program operated by Tehama County Department of Education on the Olive View Elementary School grounds.

Operating hours are 7:45am-10:45am, 11am-2pm, 2:15pm-5:15pm, Mon-Fri. The facility is closed during the summer and school holidays. 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. The site supervisor stated poisons are not stored on site and none were observed during today's visit. The toys, floors, desks and other equipment appeared clean and safe. There is drinking water available to children both indoors and outdoors. The children's bathrooms appeared in safe and sanitary condition. Food is prepared on site; one snack for each session is provided. A current menu was posted. Food prep areas are clean. Food is properly stored. Garbage cans containing solid waste have tight fitting lids. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. The playground is completely fenced and free of hazards. The playground equipment appeared in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. Children and staff records were reviewed. Some staff immunization's were missing. This facility provides Incidental Medical Services – IMS. 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: http://www.ada.gov/childqanda.htm. During today's visit staffing ratios were being met. At least one staff member present possessed current CPR and First Aid certifications. This report was reviewed and discussed with the director. SIDS pamphlet was provided. Appeal Rights were provided. All licensing reports are public information and must be made available upon request.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5948-
LICENSING EVALUATOR NAME: Christen ArcherTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2017
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: OLIVE VIEW STATE PRESCHOOL
FACILITY NUMBER: 525405507
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2017
Section Cited
1596.7995H&S
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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.

Prrof of required immunizations were not in staff files for staff #1-3 (Confidenial Names LIC 811).
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The director agreed to obtain copies of required immunizations and submit to Community Care Licensing as proof of correction by 5/26/17.
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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: Jordan MonathTELEPHONE: (530) 895-5948-
LICENSING EVALUATOR NAME: Christen ArcherTELEPHONE: (530) 895-4230
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2017
LIC809 (FAS) - (06/04)
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