243808256-10-28-2019-04-CC-GBAA-BHDRVX-20191028132217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243808256
Report Date: 10/28/2019
Date Signed: 10/28/2019 01:22:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	BELLEVUE HEAD START		FACILITY NUMBER:	243808256
ADMINISTRATOR:	CAMARGO, SUSAN		FACILITY TYPE:	850
ADDRESS:	1020 EAST BELLEVUE ROAD		TELEPHONE:	(209) 383-7147
CITY:	ATWATER	STATE: CA	ZIP CODE:	95301
CAPACITY:	20	CENSUS: 0	DATE:	10/28/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Juanita Burns		TIME COMPLETED:	01:40 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 random inspection was conducted by Licensing Program Analysts (LPAs) Ginny Badhesha and Claudia Henley. LPAs met with Master Teacher Juanita Burns and toured the facility inside and outside, as shown on the facility sketch. Present today was the master teacher and associate teacher. Head Start classroom is located in a portable on the Bellevue Elementary School grounds. This facility operates a morning and afternoon class during the traditional school year. Days and hours are Monday through Friday from 8:00AM to 11:30AM and 1:00PM to 4:30PM. No bodies of water present. Firearms/weapons are not allowed or stored on premises. All children present receive direct visual supervision at all times. Facility is operating within the approved licensed capacity at this inspection. All disinfectants, cleaning solutions, toxic, poisonous items, and medications are inaccessible to children. All toilets and hand washing areas are in safe and sanitary condition. All floors are clean and safe. Furniture and equipment are in good condition; free of sharp, loose or pointed parts. There is adequate heating, lighting and ventilation. Preschool provides breakfast, lunch and snacks that are delivered daily by Schelby Head Start and are not prepared on site. All food is protected from contamination, and contaminated food is discarded immediately. Solid waste storage vessels, including moveable bins, have tight fitting covers on, and are in good repair. Uncontaminated drinking water is available both indoors and out. Menus are posted at least one week in advance where an authorized representative can view them. Menus shall be dated and kept on file for 30 days and be available for review upon request. Facility has at least one functioning carbon monoxide detector that meets statutory requirements. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in safe condition and free of hazards. Areas under/around high climbing equipment and slides have sufficient bark cushioning material to absorb falls. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption through Merced County Office of Education. There are no excluded individuals present at this center. (Continued on 809-C)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip Badhesha	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: BELLEVUE HEAD START	FACILITY NUMBER: 243808256
	VISIT DATE: 10/28/2019

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Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the center. Staff records contain appropriate documentation. Children files included all required documents. At least one person trained in Pediatric CPR/First is present when children are at the facility or at off site activities. The responsible person who signs the child in/out uses their full legal signature and records the time of day. Child's admission agreement is available for review.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

Master Teacher Juanita Burns provided updated copies of LIC 500 (Personnel Report) and LIC 610 (Emergency Disaster Plan).

Licensee was provided with Lead Poisoning Facts brochure.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, in the areas evaluated no deficiency was cited during today's visit.

Exit interview conducted with Master Teacher Juanita Burns and a copy of this report was provided and discussed.

A Notice of Site Visit Form (LIC 9213) was posted on parent's board and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Gagandip Badhesha	TELEPHONE: (559) 575-6900
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019

LIC809 (FAS) - (06/04)

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