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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243808262
Report Date: 06/03/2019
Date Signed: 06/03/2019 11:32:13 AM

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:WESTSIDE HEAD START/EARLY HEAD STARTFACILITY NUMBER:
243808262
ADMINISTRATOR:PEREZ, VICKYFACILITY TYPE:
850
ADDRESS:805 TEXASTELEPHONE:
(209) 826-3483
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:56CENSUS: 30DATE:
06/03/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Misty MendozaTIME COMPLETED:
11:45 AM
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On 6/3/2019 at 10:30 AM Licensing Program Analyst (LPA), Stephanie Navarro conducted a Plan of Correction inspection. LPA met with Site Supervisor, Misty Mendoza and obtained a census.

The purpose of today’s inspection is to clear deficiencies that were previously cited on 5/21/2019. LPA was able to verify through LIS system Staff #1 cleared criminal record clearance. Criminal record clearance Plan of Correction (POC) cleared during this inspection. Site Supervisor stated she submitted work order for the tree roots but was unable to provide proof during inspection. Site Supervisor stated the tree roots have not been corrected. LPA advised Site Supervisor to obtain proof of work order and submit proof to Community Care Licensing in order to meet the Plan of Correction requirement by 6/21/2019.

Site Supervisor notified LPA today is her first day as the assigned Site Supervisor. LPA discussed the requirements for site supervisor/director change. LPA provided Site Supervisor a list of required documents to submit to Community Care Licensing (CCL) Fresno Regional office for review. LPA advised Site Supervisor all documents are required to be submitted within 30 days from today’s date.

Exit interview conducted with Misty Mendoza.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies were cited during inspection.

Notice of Site Visit LIC 9213 to be posted for 30 days. This report shall be made available to the public upon request.
SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7980
LICENSING EVALUATOR NAME: Stephanie NavarroTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
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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