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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407977
Report Date: 12/14/2021
Date Signed: 12/14/2021 02:09:01 PM

Document Has Been Signed on 12/14/2021 02:09 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:KOTASIK DAYCAREFACILITY NUMBER:
525407977
ADMINISTRATOR:JESSIE RADCLIFF ISLASFACILITY TYPE:
850
ADDRESS:2 SUTTER STREET, SUITE CTELEPHONE:
(530) 727-9607
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 0DATE:
12/14/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Grace Bush and Jessie Radcliff IslasTIME COMPLETED:
11:45 AM
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The facility pre-licensing inspection was conducted by Licensing Program Analyst's (LPA), Marks and Wisehart. The applicant has applied for a capacity of 35 preschool age children. The facility was toured inside and outside. The center will operate from 7:30 am- 5:30 pm, M-F. The preschool facility consists of 2 classroom(s) serving ages 2 to 5 years old. The fire clearance was approved 8/27/21 for 35 preschoolers. The indoor capacity measured for 34 children and the outdoor yard area measured for 32 children. The licensee is requesting a share playground waiver. Therefore, the facility is approved for a capacity of 34 children. Required postings (Parents Personal Rights, Emergency Disaster Plan, Earthquake Preparedness Checklist, Menu, etc.) listed on Form LIC 311A are posted. The applicant was advised that all staff are required to have a criminal background clearance on file with Community Care Licensing. The applicant is aware of the immediate $100 per day civil penalty for anyone providing care or supervision without a criminal record clearance.
The director meets the requirements of Title 22. Children will use the fenced outdoor play area and the facility will not have more then 32 children use the play area at one time. Sign-In/Out procedure were reviewed. The applicant/director understands that if a manual Sign-In/Out procedure is used; full legal signatures are required. Cubbies are available for children to use. There are pull alarms, and there is a working carbon monoxide detector and charged fire extinguisher in the facility rated at least the 2A10BC. All Exits are marked. There are 3 bathroom with 7 toilets and 7 sinks. There are two staff bathrooms, which are separate. There is a indoor drinking fountain available and water cups will be provided and a portable jug of water and cups will be used in the playground area. The isolation area for a sick child will be established in a sick room which has a mat and an isolation bathroom will be provided. The facility has sufficient cots available for children and bedding will be washed on site weekly. Breakfast and lunch and a morning and afternoon snack will be provided at the program.
Continued

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SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2021
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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: KOTASIK DAYCARE
FACILITY NUMBER: 525407977
VISIT DATE: 12/14/2021
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(Continued from LIC 809)

The food is properly stored, and refrigeration is provided. Age appropriate toys and activities are available for children. There is artificial rubber cushion material underneath the play structures sufficient to absorb falls. There are no bodies of water located on the property and none are to be added without prior notification and approval of the licensing agency. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated 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)/ (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. This report, as well as the Guide to Safe Sleep Practices brochure, Lead Exposure Testing and COVID Guidance were reviewed and discussed with the applicant/director. All licensing reports are public information and must be made available upon request for at least three years.


Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
LIC809 (FAS) - (06/04)
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