073402613-9-25-2019-02-CC-MMEA-BGCQYM-20190925123521

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402613
Report Date: 09/25/2019
Date Signed: 09/25/2019 12:35:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	CONTRA COSTA CO. HEAD START - BALBOA CDC		FACILITY NUMBER:	073402613
ADMINISTRATOR:	KHAWAJA, AMBREEN		FACILITY TYPE:	830
ADDRESS:	1001 - SOUTH 57TH ST		TELEPHONE:	(510) 374-7025
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94804
CAPACITY:	48	CENSUS: 6	DATE:	09/25/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ambreen Khawaja		TIME COMPLETED:	12:45 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 Case Management Visit was conducted on this date 9/25/19 by Licensing Program Analysts (LPAs), Mayla Mendoza & Loretta Dyson. LPAs met with center director, Ambreen Khawaja. The center has removed a classroom from their license with no increase in the number of children they are currently licensed for. Center also has a preschool component onsite. A health and safety inspection was conducted inside and outside. Hours of operation are from 7:00am-5:30pm, Monday through Friday. The measurements are as follows: INDOORS: 1321.14 square feet = 38 children OUTDOORS: 3636.98 square feet = 48 children First aid supplies are available in the center. Facility has a functioning carbon monoxide detector. There are 8 sinks and 3 toilets available for children. There is a separate crib area which can hold up to 6 crib-aged infants. Diaper changing area is within arms reach of a sink. The yard is fenced in all around and all climbing structures are cushioned with poured rubber. Trees and canopies provide sufficient shade in the play yard. Breakfast, lunch and snacks are provided to older infants, as well as the younger infants. This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CONTRA COSTA CO. HEAD START - BALBOA CDC	FACILITY NUMBER: 073402613
	VISIT DATE: 09/25/2019

NARRATIVE

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A review of staff records on 9/25/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The center has obtained an approved fire clearance on 9/20/19.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

There were no deficiencies cited during this visit.

A license for 38 infants in Building Modular A only will be licensed effective today 9/25/19.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019

LIC809 (FAS) - (06/04)

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