<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 574500623
Report Date: 09/06/2022
Date Signed: 09/06/2022 11:54:53 AM

Document Has Been Signed on 09/06/2022 11:54 AM - 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:WOODLAND HAVEN PRESCHOOLFACILITY NUMBER:
574500623
ADMINISTRATOR:DANIELLE CINDERFACILITY TYPE:
830
ADDRESS:1738 COTTONWOOD STREETTELEPHONE:
(530) 312-6690
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 42TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/06/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Keri AokiTIME COMPLETED:
10:30 AM
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
Application Specialist (AS) Alecia Sifuentes met with Licensee, Keri Aoki for the purpose of an announced pre-licensing inspection. Licensee requests an infant license to serve 20 infant children from birth to two years of age and 22 toddlers age 18-36 months under the Toddler Option Program. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The facility will be providing breakfast, snacks, and formula. Parent will provide the breast milk and baby food for their children.

AS reviewed with Licensee the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. AS discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. AS also informed applicant 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.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: WOODLAND HAVEN PRESCHOOL
FACILITY NUMBER: 574500623
VISIT DATE: 09/06/2022
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
26
27
28
29
30
31
32
INDOOR ACTIVITY SPACE:
There is one infant classroom and one toddler classroom. AS observed a sufficient amount of equipment, toys, tables, chairs, high chairs, cubbies, napping cots, and 8 cribs. Licensee acknowledges there will be a maximum of 8 infants under 12 months old, due to available cribs. There is a first aid kit in each of the classrooms. Medications will be stored in the locked box in the kitchen. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Licensee stated there are no poisons or firearms on the premises. Licensee stated there will be a water brita available in the classroom. AS observed a functional carbon monoxide detector in each classroom. AS observed an electronic sign-in/sign-out system.

AS measured the classrooms. The total classroom space contains a total of 1,823 square feet, which will accommodate Licensee's request for 20 infant children and 22 toddler children. There are 2 toilets, 8 potty chairs, and 6 sinks for the children, and a separate private restroom for the staff. Licensee stated that the second infant sink is being installed today which will be located next to the diaper changing table. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one infant and toddler outdoor area on the property. The outdoor play area is fenced with a wooden fence that is at least four feet tall that is separated from the preschool yard. Licensee has requested a Shared Outdoor Space Waiver and has provided AS with the outdoor schedules showing no commingling between the programs. There is no play structure. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

AS measured the outdoor activity space. The outdoor play area contains a total of 3,018 square feet, which will accommodate Licensee's request for 20 infant children and 22 toddler children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Report continues LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: WOODLAND HAVEN PRESCHOOL
FACILITY NUMBER: 574500623
VISIT DATE: 09/06/2022
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
26
27
28
29
30
31
32
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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.

AS discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Licensee 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.

Licensee 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 Licensee, Keri Aoki.

The following items are required before a license will be issued:
1. Granted fire clearance (STD850).
2. Video of working sinks and toilets.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3