173001847-5-2-2019-01-CC-CARD-BBSQZN-20190502123702

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 173001847
Report Date: 05/02/2019
Date Signed: 05/02/2019 12:37:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	NCO HEAD START - UPPERLAKE		FACILITY NUMBER:	173001847
ADMINISTRATOR:	MICAH HALE		FACILITY TYPE:	850
ADDRESS:	629 SECOND STREET		TELEPHONE:	(707) 275-2721
CITY:	UPPERLAKE	STATE: CA	ZIP CODE:	95485
CAPACITY:	24	CENSUS: 15	DATE:	05/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Margaret		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	An annual inspection was made to the facility by Licensing Program Analyst (LPA) Chris Arnhold. The facility file was reviewed prior to this visit. A review of staff records 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 facilities operating hours are 8:00 AM- 2:00 PM Monday - Friday. All children were under visual supervision. There are no: bodies of water, weapons, firearms, or poisons on site. Disinfectants, toxins and other hazards were not accessible to children. Materials and surfaces appear safe and toxic free. There is uncontaminated drinking water available to children both indoors and outdoors via drinking fountains. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Menus for the week are posted near the kitchen. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is cushioning underneath climbing structures and/or play equipment to absorb falls. Outdoor play area is completely fenced. During today's inspection, staffing ratios were being met, and 15 children were being supervised by 5 teachers/aides. The facility was operating within the licensed capacity. Disaster drills are conducted monthly, and last drill documented on 04/25/2019. At least one staff member present during the visit possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. At approximately 10:55am, 5 children’s records were reviewed and contained signed admission agreements, notice of parental rights and immunization records. Four staff records were reviewed at approximately 11:25am and contained documentation of education and training as required. This facility is providing Incidental Medical Services (IMS). An IMS procedure was submitted to the Department and is on file. The Department’s IMS policy was discussed with the Site Supervisor. Continued on LIC809-C.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: NCO HEAD START - UPPERLAKE	FACILITY NUMBER: 173001847
	VISIT DATE: 05/02/2019

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For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the assistant site supervisor. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5056
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

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