243810088-10-30-2019-04-CC-CBRN-BHFQVP-20191030123041

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243810088
Report Date: 10/30/2019
Date Signed: 10/30/2019 12:30:53 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:	CAMPUS PARK HEAD START		FACILITY NUMBER:	243810088
ADMINISTRATOR:	SUSAN CAMARGO		FACILITY TYPE:	850
ADDRESS:	1231 6TH ST		TELEPHONE:	(209) 381-5170
CITY:	LIVINGSTON	STATE: CA	ZIP CODE:	95334
CAPACITY:	40	CENSUS: 0	DATE:	10/30/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Christie Hendricks		TIME COMPLETED:	12:00 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 prelicensing inspection visit was conducted on this date by Licensing Program Analyst (LPA) Cynthia Brannon, who met with Assistant Superintendent, Christie Hendricks. Licensee is Merced County Office of Education. The licensee is requesting a capacity of 48 preschool children. This program will operate year round, traditional school year, Monday through Friday from 8:00 AM to 2:30 PM. Breakfast, lunch, snack will be provided and prepared off site. There is a sink with hot water inside kitchen, classroom to use for food preparation. Ill children and staff will utilize the bathroom located in the entry way. Ill children will be isolated in the staff office. Room measurements taken and reviewed with Christie Hendricks. There are two classrooms that will be used by preschool children. The total preschool square footage is 1893 which will accommodate requested capacity of 48 preschool children. Adequate storage space available for children's belongings. Outdoor storage is not available for toys and equipment. There are plans to install two locked storage sheds for the children's toys and equipment. CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

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: CAMPUS PARK HEAD START	FACILITY NUMBER: 243810088
	VISIT DATE: 10/30/2019

NARRATIVE

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Outdoor measurements taken on this date total 18060 square feet which will accommodate the requested capacity of 48 preschool children. Adequate shade is available in the outdoor activity area. The outdoor play area consists of three grass areas, two sand boxes and sidewalk. There is no climbing equipment.

There are 5 toilets and 4 sinks/hand washing fixtures in the children's bathrooms which will accommodate the requested capacity of 48 preschool children. Licensee is utilizing igloos for indoor/outdoor drinking water with disposable cup dispenser with disposable cups. An Igloo will be utilized for outdoor drinking water.

The fire clearance has been received and approved for 40 preschool children. However, due to the measurements reflecting that facility will accommodate a capacity of 48 preschool children, licensee is requesting to be licensed for the 48 preschool children. An updated fire clearance for 48 preschool children and an updated LIC 200A application will be required.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: http://www.ada.gov/childqanda.htm
CONTINUED ON FOLLOWING PAGE

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

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: CAMPUS PARK HEAD START	FACILITY NUMBER: 243810088
	VISIT DATE: 10/30/2019

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The following items must be completed prior to issuing a license by:
1. Door alarms on the following doors: in classroom #1, there is a door leading from the children's bathroom to the outside play yard and the entrance door leading into the facility.

Pending a final file review and completion of above item, a recommendation will be made to license the above facility for a capacity of 48 preschool children.

The following documents should be posted at the facility:
* PUB 269- Child passenger restraint systems poster 101225(f) Transportation
* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)

To order forms, etc. visit our website at www.ccld.ca.go

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Cynthia Brannon	TELEPHONE: (559) 341-5155
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

LIC809 (FAS) - (06/04)

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