233001386-11-1-2022-01-CC-MTRH-CKRP6F-20221101110214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 233001386
Report Date: 10/28/2022
Date Signed: 11/01/2022 11:02:23 AM

Document Has Been Signed on 11/01/2022 11:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	NCO HEAD START - CHILD DEV. CTR. - S. UKIAH		FACILITY NUMBER:	233001386
ADMINISTRATOR:	STUART, KATHY		FACILITY TYPE:	850
ADDRESS:	2161 SOUTH STATE STREET		TELEPHONE:	(707) 462-0253
CITY:	UKIAH	STATE: CA	ZIP CODE:	95482
CAPACITY:	44	CENSUS: 14	DATE:	10/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Ana Gonzalez, Teacher		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	A required annual inspection of the facility was conducted by Licensing Program Analyst (LPA) Mary Trinh. The facility file was reviewed prior to this inspection. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This classroom does not have an Infant/ Toddler program. The facility’s operating hours are 7:30 am – 4:00 pm, Monday – Friday. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children in the inaccessible, and key locked cupboard. Teacher, Ana Gonzalez (T1) stated there are no poisons in the facility, and none were observed during this inspection. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe, and in good condition. There is drinking water available to children both indoors and outdoors by use of fountain in the classrooms and water bottles on the playground. The children's bathrooms are in safe and sanitary condition. Snacks, breakfast and lunch are provided by the Center. Food prep areas were observed to be clean. Food was observed to be properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. At least one staff member present possessed current CPR and First Aid certifications. Mandated Reporter training is up to date. Full signatures were observed on sign/in, sign/out sheets. The LPA Trinh 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 are wood chips cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. Continued...

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary Trinh	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NCO HEAD START - CHILD DEV. CTR. - S. UKIAH	FACILITY NUMBER: 233001386
	VISIT DATE: 10/28/2022

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
26
27
28
29
30
31
32

The T1 stated no weapons are stored on site and none were observed.
T1 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.
Children's records (6) were reviewed at 2:45 pm. Staff records (3) were reviewed at

2:35 pm.

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, a Plan for Providing 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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Teacher, Ana Gonzalez.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at: www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Mary Trinh	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2