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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125400415
Report Date: 01/20/2022
Date Signed: 01/21/2022 10:23:21 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:HEAD START - REDWAY/GARBERVILLEFACILITY NUMBER:
125400415
ADMINISTRATOR:DOUGLAS, ROSEFACILITY TYPE:
850
ADDRESS:334 EMPIRE AVETELEPHONE:
(707) 923-4691
CITY:REDWAYSTATE: CAZIP CODE:
95560
CAPACITY:20CENSUS: 6DATE:
01/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Rose DouglasTIME COMPLETED:
03:15 PM
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On 01/20/2022 at 11:45 AM, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Kiriko Lynch. This program is operated by Head Start and a Title 5 funded program. The program days and hours of operation are 8:30 AM to 12 PM, Monday–Thursday. The facility was toured at 11:45 AM inside and outside and the floor and yard plan submitted by the licensee were verified. The facility representative and two assistants were supervising six children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises. The outdoor activity space was cushioned with foam rubber and free of hazards. Facility representative was reminded that all adults 18 and over, 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. 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. There were no deficiencies cited during today’s inspection. Exit interview was conducted with facility representative, and notice of site visit was provided.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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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