073402613-8-29-2019-02-CC-PPEN-BFHUF6-20190829153214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402613
Report Date: 08/29/2019
Date Signed: 08/29/2019 03:32:20 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:	RHAMES, KATHERINE		FACILITY TYPE:	830
ADDRESS:	1001 - SOUTH 57TH ST		TELEPHONE:	(510) 374-7025
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94804
CAPACITY:	48	CENSUS: 25	DATE:	08/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Ambreen Khawaja		TIME COMPLETED:	03:30 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) Paul Petersen conducted an unannounced random annual site inspection for this facility at 1230. LPA met with and toured all areas of this Title 5 infant facility utilized by children in care with facility director, Ambreen Khawaja, for a health and safety inspection. This infant care facility is currently operating out of portable A1, A2, A3 and portable B2. This facility is currently licensed for the use of portable B3, but the room is not currently being used by the program and an application has been submitted to change the room to a preschool room. There are 25 infants present, including five crib age infants, along with eight teaching staff, comprised of seven qualified teachers and one aide. The facility is within ratio and capacity. There is also an preschool component located on site and the infant indoor and outdoor activity areas are distinctly separate to the preschool areas and children from the different programs do not commingle. Furnishings and equipment, including infant sleeping equipment, are age appropriate and in good repair. There are six napping cribs and one evacuation crib present. There are no toxins or hazardous items observed to be accessible to children in care. Per director, the most recent fire dept. inspection was approximately March of 2019. There are fully charged fire extinguishers and a working carbon monoxide detectors present. There is a centralized smoke/fire alarm system. Floors and surfaces, including counter tops, are free of toxins and hazardous conditions. Per director there are no firearms present or stored on the premises. This facility provides breakfast, lunch and snacks which are catered daily from the main CCC Head Start kitchen. There are menus posted for review. Food prep and storage areas appear clean and free of pests. Infants formula/feedings from home are appropriately stored and labeled. Drinking water is observed to be available for children in care both indoors and out via working water fountains, water pitchers and cups. Sinks and toilets are age appropriate. Changing tables are within arms reach of faucets. Mats are used for older infants napping. Crib area is separated via an appropriate barrier from activity area. Mats are stored and used per individual child and linens are kept separate per each child's use. Continued on Page 2*************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

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: 08/29/2019

NARRATIVE

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The two infant outdoor play areas are fully enclosed/fenced. There is shade available and climbing structures/equipment are age appropriate and securely anchored with cushioning under and around the equipment. There are no observed hazardous conditions and no pools or other accessible bodies of water present.

LPA reviewed the facility, personnel and children's records including children's immunization records, infant needs and services plans, children's admissions agreements, staff teaching qualifications including infant course work and staff background clearances. Also reviewed were parental signature for enrollment beyond 24 months. All required postings are present including electronic records waiver. Multiple staff present have current CPR/First Aid certification.

This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information 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

Licensee is encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact: ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. 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. Infant Safe Sleep Awareness Campaign informational was provided.

There are no deficiencies cited during this inspection. A notice of site visit was provided along with a copy of the appeal rights. A copy of this report is to remain in the facility records for a period of 3 years.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2