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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010573
Report Date: 05/23/2024
Date Signed: 05/23/2024 01:07:12 PM

Document Has Been Signed on 05/23/2024 01:07 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CATERPILLAR CLUBHOUSE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
483010573
ADMINISTRATOR/
DIRECTOR:		CURTIS, LATASHAFACILITY TYPE:
860
ADDRESS:997 BECK AVENUETELEPHONE:
(707) 280-1826
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
05/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Latasha CurtisTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes and Licensing Program Analyst (LPA) Elpidia Hernandez Torres met with Applicant, Latasha Curtis for the purpose of an announced pre-licensing inspection. Applicant requests a preschool component to serve 30 children from age two years to entry into first grade. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The facility will be providing breakfast and snacks. The fire clearance (STD850) was granted on 12/14/2023, however the fire clearance includes a toddler component. LPA will provide the fire inspector with an amended STD850.

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:
There are five preschool classrooms located in the Bubble Bee Room, Grasshopper Room, Caterpillar Room, Butterfly Room, and the Ladybug Room. LPA observed a sufficient amount of equipment, toys, tables, chairs, napping cots, and cubbies in all rooms. There is one first aid kit located in the staff bathroom and kitchen. Medications will be stored in the office in a locked cabinet. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated that water pitchers and cups will be available, but also plans to install a water dispenser in the classroom. LPA observed a functional carbon monoxide detector in the Caterpillar Room. LPA observed an electronic sign-in/sign-out system.

Report continues on LIC809 page 2.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CATERPILLAR CLUBHOUSE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 483010573
VISIT DATE: 05/23/2024
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Page 2.

LPA measured all five preschool classrooms. The classrooms contain a total of 1,077 square feet, which will accommodate Applicant's request for 30 preschool children. There are 2 toilets and 1 sink located in the children’s restroom and 1 sink located in the Bumble Bee Room. LPA observed a separate private restroom for the staff located in the Bumble Bee Room and next to the kitchen. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property located behind the facility. The outdoor play area is fenced with a chain link fence that is at least four feet tall. LPA observed a rolling gate to fully close in the playground. LPA asked the Applicant to close the gate. LPA observed that the roller gate was difficult to close. LPA informed Applicant that the roller gate will need to be adjusted to close properly in order to make the playground fully fenced. LPA observed a sufficient amount of equipment and toys. There is no play structure. Applicant stated that they plan to install a play structure. LPA informed Applicant that the play structure will need to be approved prior to being utilized by the children. Applicant will let LPA know when they plan to install the play structure. There are no bodies of water on the premises. LPA observed a large canopy used for the shaded area on the grass.

LPA measured the outdoor activity space. The outdoor play area contains a total of 4,284 square feet, which will accommodate Applicant’s request for 30 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Report continues on LIC809 page 3.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CATERPILLAR CLUBHOUSE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 483010573
VISIT DATE: 05/23/2024
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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 discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant 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 $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant 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.

Report continues on LIC809 page 4.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CATERPILLAR CLUBHOUSE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 483010573
VISIT DATE: 05/23/2024
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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 platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Latasha Curtis.

The following items are required before a license will be issued:
1. Amended granted STD850.
2. Video of playground gate properly closing.
3. Final review of Admissions Agreement from Licensing Program Manager (LPM) Mai Lor.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4