493010463-5-10-2024-01-CC-JSNW-D53VRQ-20240508164018

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010463
Report Date: 05/08/2024
Date Signed: 05/10/2024 01:47:17 PM

Document Has Been Signed on 05/10/2024 01:47 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	YWCA HEALDSBURG PRESCHOOL		FACILITY NUMBER:	493010463
ADMINISTRATOR/ DIRECTOR:	JYNX LOPEZ		FACILITY TYPE:	850
ADDRESS:	1557 HEALDSBURG AVENUE		TELEPHONE:	(707) 546-7177
CITY:	HEALDSBURG	STATE: CA	ZIP CODE:	95448
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 56	CENSUS: 0	DATE:	05/08/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Renee Whitlock		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A prelicensing inspection was conducted May 8, 2024 by Licensing Program Analyst (LPA), J. Snow. LPA Snow met with facility representative Renee Whitlock, the applicant/licensee is requesting a license for 24 infants, age 0-2 years and 32 preschoolers age 2-5 years with a total capacity of 56 children in room #1 & 2. The facility will operate Monday-Friday, 7:30 am to 5:30 pm. The facility has 2 rooms, with 3 bathrooms, one of the bathrooms has a separate stall for staff. We have received an approved fire clearance for the 24 infants on 03/20/2024, the fire clearance will be reordered with both infants and preschoolers. The facility is located on the Healdsburg Community Center campus. There are other Children's activities in this campus that are not part of this CCLD childcare licensee. Currently the Building Blocks Preschool (age 3-5 years) 9am -1pm Monday-Friday and Tot Time for drop in toddlers from 9am -11am on Tuesday & Wednesday. An infant capacity worksheet was completed during the visit. There is not enough indoor space in infant room #2 (833.31 square ft) for the requested capacity. Infants in room #2 have 1 toilet, 2 potty chair and 3 sinks which is sufficient for the requested capacity. The Infant yard measures 1,756 sq ft which is not enough for the requested capacity. Continued on the next page

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: YWCA HEALDSBURG PRESCHOOL	FACILITY NUMBER: 493010463
	VISIT DATE: 05/08/2024

NARRATIVE

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A preschool capacity worksheet was completed during the visit. There is enough indoor space in room #1 (1070.44 square ft) which is not enough for the requested capacity. There is an attached bathroom with 1 toilet and 3 sinks, there is another bathroom which has another 3 toilets and 3 sinks plus 1 staff toilet & 1 sink. The Preschool yard measures 2,275 sq ft which is not enough for the requested capacity.
Both the infant and preschool yards are fully fenced with chain link, over 4 ft tall. There are no climbing structures. There are pop up shade structures in the infant and preschool play yards. There is an outdoor carpet for infant crawling.

Children will nap in cribs and on cots/mats in the preschool & infant classroom. There are sufficient number of mats to meet the capacity. There is a separate nap room in room #2 for infants. There are currently 6 cribs set up.

Based on the above, the maximum capacity of the facility could be 30 preschool and 23 infants for a total of 53 children.

The following areas will be off limits to children: the kitchen in the infant room which will be blocked off with a locking half door. There is a refrigerator, sink and stove for meal preparation. The facility will serve 2 snacks, breakfast and lunch. There is another stove that is in locked mode in the preschool and they do not plan to use it. The isolation area for sick children will be located in the preschool room in the corner nook. There is safe and age-appropriate furniture, toys, and play equipment available for children. There is no pool, spa, pond, fountain, or any other body of water on the premises The poisons are locked in classroom cabinets.
Continued on the next page

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: YWCA HEALDSBURG PRESCHOOL	FACILITY NUMBER: 493010463
	VISIT DATE: 05/08/2024

NARRATIVE

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Renee Whitlock, said there are no weapons on property.
Facility representative, Renee Whitlock, 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.

This facility provided a plan to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS has been submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) tollfree 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, Renee Whitlock, 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 Renee Whitlock , 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, Renee Whitlock, 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. Continued on the next page

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: YWCA HEALDSBURG PRESCHOOL	FACILITY NUMBER: 493010463
	VISIT DATE: 05/08/2024

NARRATIVE

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Representative, Renee Whitlock, 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.

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.

Exit interview conducted and report was reviewed with the or facility representative, Renee Whitlock,
The following items need to be completed prior to the granting the license:
1. Updated fire clearance to match the capacity (LPA ordered on 5/8/24)

2. Updated LIC 200a to match maximum capacity of 30 preschool and 23 infants

3. Verification of infant units for the director

4. Mandated Reporter Training for the director

5. Proof of flu immunization or decline in writing

6. LIC 309 list of officers, terms, phone & address to be attached

7. Updated facility maps, include yard, birds eye view of entire address, bathrooms, isolation area and measurements.

8. Handbook: reference to the requirements to complete the Consent for emergency information and Childs pre admission health history

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC809 (FAS) - (06/04)

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