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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483008621
Report Date: 01/31/2024
Date Signed: 01/31/2024 02:14:05 PM

Document Has Been Signed on 01/31/2024 02:14 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BENICIA USD - MATTHEW TURNER PRESCHOOLFACILITY NUMBER:
483008621
ADMINISTRATOR:REGIS, JUNEFACILITY TYPE:
850
ADDRESS:540 ROSE DRIVETELEPHONE:
(707) 747-8367
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 20DATE:
01/31/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Maribel "Mari" RomeroTIME COMPLETED:
12:30 PM
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A Case Management – Annual Continuation visit was made to the Benicia Unified School District office located at 350 East K St., Ste 11, Benicia, CA 94510 by Licensing Program Analyst (LPA),Selena Mariani. LPA met with facility representative, Erica Dudley.

During today’s visit LPA reviewed five children files and contained completed records as required. Two staff files were reviewed. At least one staff member, Staff 1 (S1), present during the required inspection completed on 01/19/2024, possessed current pediatric CPR and First Aid certifications, S1 certificate expires on 02/2024.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

An exit interview was conducted, and the report was reviewed with facility representative, Erica Dudley.

There were no Title 22 deficiencies cited during today's file review.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Selena Mariani
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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