243810089-11-6-2019-04-CC-CBRN-BHFSUR-20191030141136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243810089
Report Date: 10/30/2019
Date Signed: 11/06/2019 10:01:17 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:	SHATTUCK PARK HEAD START		FACILITY NUMBER:	243810089
ADMINISTRATOR:	JANET BENZIGER		FACILITY TYPE:	850
ADDRESS:	10082 VINCENT RD		TELEPHONE:	(209) 381-5170
CITY:	DELHI	STATE: CA	ZIP CODE:	95315
CAPACITY:	20	CENSUS:	DATE:	10/30/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Christie Hendricks		TIME COMPLETED:	02:30 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 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 60 preschool children. This program will operate a traditional school year program, 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 in the classroom. Ill children and staff will utilize the bathroom located in the back. Ill children will be isolated in the staff office. Room measurements taken and reviewed with Christie Hendricks. There are three classrooms that will be used by preschool children. The total preschool square footage is 2664 which will accommodate requested capacity of 60 preschool children. Classroom #3 does not have a child's restroom. The classroom will be staffed by three teachers, one who will escort the children to one of the other classrooms. Adequate storage space available for children's belongings. Outdoor storage is available for toys and equipment. The storage is located in another building on site. 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: SHATTUCK PARK HEAD START	FACILITY NUMBER: 243810089
	VISIT DATE: 10/30/2019

NARRATIVE

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Outdoor measurements taken on this date total 6580 square feet which will accommodate the requested capacity of 60 preschool children. Licensee is utilizing two mature trees for shade. The outdoor play area consists of two grass areas. There is no climbing equipment.

There are 4 toilets and 4 sinks/hand washing fixtures in the children's bathrooms which will accommodate the requested capacity of 60 preschool children. Licensee is utilizing igloos for indoor/outdoor drinking water with disposable cup dispenser with disposable cups. In classroom #1 and #2 have one sink in each room, designated for classroom use, not to be used for toileting purposes.

The fire clearance has been received and approved for 60 preschool children. Facility has a working carbon monoxide on site.

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: SHATTUCK PARK HEAD START	FACILITY NUMBER: 243810089
	VISIT DATE: 10/30/2019

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The following items must be completed prior to issuing a license by:
1. There is torn wall paper in both of classroom #3 rooms.
2. There are bolts in the outside fencing. The bolts are to be cut back 3 to 4 threads.
3. Classroom #3 does not have a sink for classroom purposes. Per licensee, a portable sink will be installed.

Pending a final file review and completion of above items, a recommendation will be made to license the above facility for a capacity of 60 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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