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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065408373
Report Date: 08/26/2024
Date Signed: 08/26/2024 02:36:10 PM

Document Has Been Signed on 08/26/2024 02:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:COLUSA EARLY LEARNING CENTERFACILITY NUMBER:
065408373
ADMINISTRATOR/
DIRECTOR:		PADILLA, ANGELAFACILITY TYPE:
860
ADDRESS:723 6TH STREETTELEPHONE:
(530) 458-4458
CITY:COLUSASTATE: CAZIP CODE:
95932
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
08/26/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Vikki Marks TIME VISIT/
INSPECTION COMPLETED:
02:29 PM
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LPA Snow met with applicant V.Marks to go over the application
the following is still needed:
A9 Personnel Report (LIC 500)
☐ Must list Director, Teacher, Aide (Infant or Toddler Teacher)
☐ Must show enough staff to cover full capacity (including lunch & breaks)
☐ Covers the hours of operation listed on the lic200a.
☐ Page 2 is signed.
☐ For schools, exempted staff should be listed on page 2.
Complete with staff as if at full capacity all ages
A12. LIC 610 Form
☐ Don’t use 911 or 800 numbers (except poison control 1-800-222-1222)
☐ None of the relocation sites are licensed daycare facilities (because of maximum capacity)
☐ Letters of permission from both relocation sites saying they authorize your facility to temporarily relocate the children to their address in case of emergency.
Second relocation site and letter
A14 Facility Sketch (Floor Plan) (LIC 999)
SEE Guide provided today
B3. Job Descriptions
See guide provided today
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: COLUSA EARLY LEARNING CENTER
FACILITY NUMBER: 065408373
VISIT DATE: 08/26/2024
NARRATIVE
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B6. Parent Handbook/Program Description/Admission Policies & Procedures/Discipline Policies
Child Care Program Description.
PLEASE NUMBER THE PAGES OF THE HANDBOOK
Page #
1. ___ Statement of philosophy, purpose, goals, and program method -describe the program

2. ___ Days and hours of operation -if the handbook is used for multiple facilities, then include an addendum page with the hours & ages of this location.

3. ___ Category and age of children accepted for care -infant 0-24 months, toddlers 18-36 months, preschool 2-5 years, school age 5-12 years

4. ___ Supplementary services- if additional services are offered, otherwise say no supplementary services offered.

5. ___ Field trip provisions -provide the guidelines, permission slips & who would drive or say no field trips.

6. ___ Transportation arrangements -(provide the guidelines, permission slips & who would drive or say no fieldtrips

7. ___ Food service provisions (meal and snack time) – state which meals will be provided.

a. If infant facility, include a milk/bottle policy explaining who is responsible for providing milk & expectations for providing and cleaning bottles.

b. If asking parents to provide snacks or meals, you must provide information on minimum food groups for lunch & snack & serving size expectations to the parent.

8. ___ Medication policy/ IMS plan- needed for nebulizer & Epi pen (sample plan available)

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: COLUSA EARLY LEARNING CENTER
FACILITY NUMBER: 065408373
VISIT DATE: 08/26/2024
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9. ___ Services provided during a medical and dental emergency – statement that you will call parents and 911 if needed.

10. ___ Sign in/sign out procedures -require full signatures for parents on pickup & drop off

11. ___ Resting & Relaxation (Naptime) – if there is no nap then state that there is a rest time available.

12. ___ Provisions for infant safe sleep- if you have children under 24 months. To include infant napping log, LIC 9227, and infant sleeping equipment - Describe how the infant will meet the sleep requirements so the parents are aware.

13. ___ Needs and Services Plans – if you accept children under 12 months. State that the parent will provide this information update every 90 days.

Admission Policies:

14. ___ Criteria for determining appropriate placement given child’s needs (parent interviews, pre- admission appraisal, etc.) –should include assessments showing that you determine if the child is appropriate for the facility, required meetings or tours or anything that is required prior to accepting children for care.

Notify the parents’ & authorized representative that the following will be required as part of the enrollment process:

15. ___ Notification of Parents’ Rights form (LIC 995)

16. ___ Personal Rights form (LIC 613A)

17. ___ Identification & emergency information (LIC 700)

18. ___ Consent for Emergency Information (LIC 627)

19. ___ Child’s Preadmission Health History-Parents Report (LIC 702)

20. ___ Physician’s Report-Child Care Centers (LIC 701)

21. ___ Proof of current Immunization records

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: COLUSA EARLY LEARNING CENTER
FACILITY NUMBER: 065408373
VISIT DATE: 08/26/2024
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Discipline Policies

Page #

22. ___ Types of disciplines and conditions under which they are used – list the types of behaviors or scenarios that could result in discipline

23. ___ Types of discipline not permitted included. No Corporal Punishment/Violation of Personal Rights.

24. ___ Policy requiring contacts/conferences with parents when behaviors are serious or ongoing.

25. ___ Grounds for dismissal/removal included – under what condition will you remove a child and what steps will you take (i.e. the parent will be contacted, behavior will be documented, teacher and parent conferences will be held to discuss behavior, a plan will be in place to help the behavior ….)

B8 Admission Agreement


☐ Must be a standalone document and not part of the handbook
☐ Description of basic services offered (examples include supervise the children in a safe environment or provide afterschool homework assistance).
☐ Description of optional services offered. (example would be gymnastics or late pickup)
☐ Payment provisions, such as rates for basic and optional services, due date(s) and frequency of payments.
☐ Modification conditions. (Statement to ensure that at least 30 days’ advance notice will be given prior to any rate change.)
☐ Refund policy. (you may state no refunds)
☐ Rights of the licensing agency. (CCL has the right to inspect the facility and interview children without prior authorization)
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: COLUSA EARLY LEARNING CENTER
FACILITY NUMBER: 065408373
VISIT DATE: 08/26/2024
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☐ Reasons for termination.
☐ Signed and dated by director and parent.
☐ If toddler option, then add a signature line for written permission to place the child in the preschool.
If toddler option, then add a signature line for written permission to place the child in the preschool.

Other:
☐ Request Common Waiver/Exceptions: existing waiver may have to be addressed


(D) Directors Name: Angela

1. ☐ Evidence of current tuberculosis clearance (A11)


2. ☐ Board resolution to authorize director to be in charge of day-to-day operations at the facility. (B1)
3. ☐ Preventive health practices course, including Childhood Nutrition and Lead Exposure (B2)
4. ☐ Immunization against Measles (MMR), Pertussis (Tdap) Influenza (flu can be declined) (B2)
5. ☐ Child Care Center Orientation- Component II - Operations and Record Keeping (B2)

(AR) Authorized Representative/person who signs the Lic200a.

Name: Vikki

6. ☐ Criminal record clearance or exemption associated to the facility. (B14)


7. ☐ Immunization against Measles (MMR),
8. ☐ Mandated reporter training certificate (childcare).
finished
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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