033607205-1-22-2020-53-CC-ASRN-BL3SDF-20200122124703

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 033607205
Report Date: 01/22/2020
Date Signed: 01/22/2020 12:47:11 PM

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:	AMADOR-TUOLUMNE COMMUNITY ACTION AGENCY HEAD START		FACILITY NUMBER:	033607205
ADMINISTRATOR:	BUCHANAN, SANDY		FACILITY TYPE:	850
ADDRESS:	108 WEST MARLETTE ST.		TELEPHONE:	(209) 274-0395
CITY:	IONE	STATE: CA	ZIP CODE:	95640
CAPACITY:	20	CENSUS: 14	DATE:	01/22/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:19 AM
MET WITH:	Paulo Consolo		TIME COMPLETED:	01:05 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	Licensing Program Analyst (LPA) Aruna Sridharan met with administrator Paula Consolo for an unannounced annual inspection. The census was 14 children with three staff members. The hours of operation are Monday through Friday from 8:00am to 2:00pm. The facility provides am/pm snacks and lunch. LPA toured the classroom, restrooms and outdoor play area. LPA observed appropriate ratios, care and supervision, and capacity during the visit. The school year began on July 31, 2019 and last day is May 29, 2020. Medications, disinfectants, cleaning solutions, and hazardous items were appropriately stored and inaccessible to children. First Aid was centrally located but inaccessible to children. Furniture, equipment, and play materials were in good condition. Playground equipment was free of loose and sharp parts. The areas under and around playground climbing equipment were cushioned with wood chips to absorb falls. There is 1 toilet and 2 sinks. Toileting facilities were in operating and sanitary condition. Uncontaminated drinking water is readily available to children both indoors and outdoors. LPA observed a current menu posted. LPA observed Sign In/Out Sheet with signatures, times, and dates. The facility conducts fire drills and the last one was conducted on 01/04/2020. The children's roster was current. LPA reviewed 6 children’s files and observed that each child had their Identification/Emergency Information and the Consent for Medical Treatment form filled out and signed by their authorized representative. Report continues on 809C page......

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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 2

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: AMADOR-TUOLUMNE COMMUNITY ACTION AGENCY HEAD START	FACILITY NUMBER: 033607205
	VISIT DATE: 01/22/2020

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

At least one staff member present today had current Pediatric CPR and First Aid certification (expires 08//20). All staff currently employed with the facility have proof of immunizations. LPA also reviewed documentation of qualifications including education and experience. All staff members have completed Mandated reporter training(AB1207).

LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regards to new regulations.
LPA discussed the Incidental Medical Services (IMS) policies with the licensee. The facility is currently providing IMS; however, LPA discussed the IMS policy. For IMS information see the Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and Medication Regulations 101226. 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), 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: www.ada.gov/childqanda.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report and provided copies to the facility. An exit interview was conducted. Appeal Rights were provided and Notice of Site Visit posted and the director understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna Sridharan	TELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2