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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243810099
Report Date: 07/24/2020
Date Signed: 07/30/2020 11:35:00 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:TENAYA HEAD STARTFACILITY NUMBER:
243810099
ADMINISTRATOR:ISABEL ABUNDEZFACILITY TYPE:
830
ADDRESS:760 W 8TH STTELEPHONE:
(209) 381-5170
CITY:MERCEDSTATE: CAZIP CODE:
95334
CAPACITY:12CENSUS: 0DATE:
07/24/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Monica GarzaTIME COMPLETED:
02:45 PM
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On 07/24/2020, Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an announced prelicensing inspection and met with Assistant Director, Monica Garza. LPA explained the reason of the inspection and a tour of the center was conducted both inside and outside. The center is located on the premises of Tenaya Middle School at 760 W 8th St In Merced, CA. The licensee is requesting an Infant license with a capacity of 8 infants, including up to 4 crib babies. This program will operate year round from Monday through Friday 7:30 AM to 5:30 PM. This program will operate in classroom number #1. Licensee will provide formula, breakfast, lunch, and snack. Breakfast, lunch, and snacks are provided by the centralized kitchen and brought over to the facility. Monica stated that a staff person brings the food into classrooms. Ill children and staff will utilize the bathroom located down the hall. Ill children will be isolated in the office. A working carbon monoxide is installed.

Room #1’s measurements were taken and reviewed with Monica. The total inside infant area is an approximate 305 square feet which will accommodate the requested capacity of 8 infants. LPA observed the crib area available, which can accommodate 4 crib infants and 8 sleeping cots. Monica stated that a refrigerator will be installed for the infants formula, bottles, and infant food. The changing table will need to be moved closer to the sink to be arms length. This sink will not to be used for food preparation. Monica will submit pictures once table is moved. Outdoor storage is available for toys and equipment. Outdoor measurements were taken on this date for the infant playground and totaled to an approximate 3,399 square feet which exceeds the requested capacity of 8 infants. Infant play yard will only be used for infants. Monica stated she will get a pop up shade structure to provide more shade. The Licensee is currently utilizing a tree for shade. there are 2 toilets in 4 sinks in the infant room for potty training. There is no climbing equipment in the infant outside play yard.

A fire clearance for 08 infants was approved by the Merced County Fire Department on 05/13/2020.



Continued on next page LIC 809-C
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2020
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: TENAYA HEAD START
FACILITY NUMBER: 243810099
VISIT DATE: 07/24/2020
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes 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

The following items must be completed prior to issuing a license by 08/10/20:


1. Get pop ups to provide more shade in the pay yard.
2. Get refrigerator.
3. Move changing table closer to sink.

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)
* Activity Schedule
* Lead Poisoning brochure
* Shaken Baby brochure
* Safe Sleep Brochure

Pending a final file review and a completion of the above items, a recommendation will be made to license the above facility for a capacity of 8 infants children.

No deficiencies cited during today's visit.
A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2