Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570312670
Report Date: 04/27/2016
Date Signed 04/27/2016 11:01:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ROBERT E. WILLETT SCHOOL AGE CDCFACILITY NUMBER:
570312670
ADMINISTRATOR:ANGELO, MARISSAFACILITY TYPE:
840
ADDRESS:1207 SYCAMORE LANETELEPHONE:
(530) 758-8342
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:70CENSUS: 5DATE:
04/27/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Magan Kelly and Steve GunnTIME COMPLETED:
11:15 AM
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LPA Joseph Bweupe met with teachers in charge Megan Kelly for an annual random visit. Teacher stated that site supervisor was not at facility during the visit. However, site supervisor arrived at facility during LPA's visit. LPA toured the facility, including all activity/classroom areas, isolation area, food service area, rest-rooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications and first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions. LPA observed all required forms to be posted. Facility had 5 children in care with 2 staff members.

Facility had medications stored in the top kitchen cabinet inaccessible to children. Some first aid materials were available. LPA did not observe sleeping mats. Teacher stated that that facility operates from 8.30 to 11.50am Mondays, Tuesdays and Fridays. Wednesdays 8.30am to 10.10am.Teacher stated that Kinder children were at facility for a 3 hour program and so children did not take any naps. Facility had adequate toys available for children. The rest-rooms were in working order. The center provides morning snacks and lunch. Menus were posted on the refrigerator in the kitchen. All staff present had criminal record clearances. Center has an updated fire drill log. LPA reviewed the sign in/out sheets, children's and personnel records. Children's files had identification (LIC 700) and health information (LIC 702). At least one staff member present ad current Pediatric CPR and first Aid. LPA advised teacher of cite visit posting requirement and the licensee/supervisor requirement to post reports with include type A deficiencies. LPA provided the licensing Agency website www.ccld.ca.gov for the teacher and staff to obtain updated information, regulation and forms.

Facility provides Incidental Medical Services (IMS). LPA reviewed the storage of medication and equipment and supplies.

There were no deficiencies during the visit. Exit interview was conducted. Notice of visit was posted
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Joseph BweupeTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2016
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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