090321692-2-6-2020-03-CC-MPAL-BLJPV3-20200206103829

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 090321692
Report Date: 02/06/2020
Date Signed: 02/06/2020 10:38:35 AM

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:	PINEWOOD HEAD START		FACILITY NUMBER:	090321692
ADMINISTRATOR:	TOMBS/STOWE		FACILITY TYPE:	850
ADDRESS:	6181 PINE ST.		TELEPHONE:	(916) 647-0312
CITY:	POLLOCK PINES	STATE: CA	ZIP CODE:	95726
CAPACITY:	20	CENSUS: 14	DATE:	02/06/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Darlene Woods		TIME COMPLETED:	10:50 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	Licensing Program Analyst (LPA) MIchelle Pascual met with teacher Darlene Woods for an unannounced annual random inspection. Upon arrival there were fourteen (14) children present. The facility is open Monday-Friday. This program operates in the Head Start portable from 8:00am - 02:30 pm and follows the Pollock Pines School district schedule. The facility provides breakfast, lunch and snack. The breakfast, lunch, and snacks are now prepared at the EDCOE main kitchen at Ken Lowry and is delivered weekly. LPA observed that all of the required forms were posted including a license, meal/snack menu that meets regulation, parents' rights' poster, emergency care and disaster plan, and seat belt law. LPA toured the facility inside and out for a health and safety inspection. PHYSICAL PLANT- LPA observed there are no bodies of water on site. There are no firearms on site. The facility appeared orderly and suitable for children. Cleaning supplies and hazardous items were inaccessible to children. Medications are stored in a safe place inaccessible to children in care. Outdoor activity space and equipment was in good repair. All toilets, hand washing, and bathing facilities are in safe and sanitary operation condition. Uncontaminated drinking water is available indoors and outside. LPA observed that solid waste bins had tight-fitting covers on and were in good repair. LPA observed a current fire/disaster drill log. EVALUATION OF CARE AND SUPERVISION- LPA observed that all children were being supervised. FACILITY RECORDS REVIEW- LPA observed the facility sign in and out sheet and all parents (authorized representatives) are completing signing their children in and out. LPA reviewed staff files and observed that staff have completed personnel health screening/TB test, AB 1207 mandated reporter training (expires 09/2021), CPR (expires 04/2021) and SB792 immunization's. LPA observed that children’s records contain their medical assessment.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: PINEWOOD HEAD START	FACILITY NUMBER: 090321692
	VISIT DATE: 02/06/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 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) 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

The facility evaluation report was reviewed and discussed with the Site Supervisor. A notice of site visit was provided and should remain posted for a period of 30 days for parental review. Site Supervisorwas encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. Their signature on this form acknowledges receipt of this form.

Based upon today’s inspection, no Title 22 deficiency was cited.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Michelle Pascual	TELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020

LIC809 (FAS) - (06/04)

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