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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125408329
Report Date: 08/09/2023
Date Signed: 08/10/2023 03:20:11 PM

Document Has Been Signed on 08/10/2023 03:20 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-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CAL POLY HUMBOLDT CHILDREN'S CENTERFACILITY NUMBER:
125408329
ADMINISTRATOR:WILSON, ELIZABETH-ANNEFACILITY TYPE:
850
ADDRESS:1350 C STREETTELEPHONE:
(707) 826-3838
CITY:ARCATASTATE: CAZIP CODE:
95521
CAPACITY: 58TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
08/09/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Betsy WilsonTIME COMPLETED:
04:30 PM
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A location change/prelicensing inspection was conducted today at 8:30 AM by Licensing Program Analyst (LPA) Kiriko Lynch. LPA met with facility representative Betsy Wilson. The public agency applicant/licensee is requesting a license for toddler/preschool children, with a capacity of 58. The facility will operate Monday-Friday, 7:30 AM to 5:30 PM. The facility has three classrooms, #104, #108, #125, three children’s restrooms, and three staff restrooms. The indoor and outdoor activity spaces were toured, and the facility sketch was verified. The following areas will be off limits to children: basement. These areas have been made inaccessible by means of locked/sealed doors. There is a kitchen to store/prepare meals and snacks. Children will nap on mats in the classrooms. There is a changing table in two children’s restrooms. The isolation area for sick children will be in the staff office. The outdoor play area is fully fenced. There are play structures for children to play on and adequate cushioning underneath. There is no pool, spa, pond, fountain, or any other body of water on the premises. There is safe and age-appropriate furniture, toys, and play equipment available for children. A capacity worksheet was completed during the visit. There is indoor space for 80 children and outdoor space for 109 children. There are seven toilets and thirteen sinks available for children. Based on the above, the maximum capacity of the facility could be 80 children, with fire marshal approval.

Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, $100 minimum/day for a maximum of 30-days per person will be assessed if this regulation is violated.

See next page
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CAL POLY HUMBOLDT CHILDREN'S CENTER
FACILITY NUMBER: 125408329
VISIT DATE: 08/09/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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.

LPA reviewed with facility representative the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility representative was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the facility representative Betsy Wilson.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Facility is licensed as of today, 08/09/2023.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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