270710358-10-17-2019-07-CC-FCJO-BH2QF3-20191017120716

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 270710358
Report Date: 10/17/2019
Date Signed: 10/17/2019 12:07:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GABILAN HEAD START		FACILITY NUMBER:	270710358
ADMINISTRATOR:	FLETES, SANDRA		FACILITY TYPE:	850
ADDRESS:	417 NORTH RUSS STREET		TELEPHONE:	(831) 385-1568
CITY:	KING CITY	STATE: CA	ZIP CODE:	93930
CAPACITY:	80	CENSUS: 23	DATE:	10/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Raquel Rodriguez		TIME COMPLETED:	12:30 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	Licensing Program Analyst (LPA), Fermin Campos-Jaramillo made an unannounced annual random inspection to the center today. LPA met with Raquel Rodriguez, master teacher, and explained the nature of today's inspection to her. LPA observed 23 children were in care today. LPA observed there were three staff members taking care of the children. LPA observed that all the staff members present during the inspection have a current CPR/First Aid certifications. LPA observed the teacher-child ratio was in compliance with regulations. LPA observed posted the forms required by this Licensing Department. LPA toured the facility inside and outside. Staff and children's toilets and sinks are safe and in sanitary operating conditions. LPA observed the storage areas are clean and free of litter. LPA observed disinfectants, cleaning solutions, sharp objects, and other similar items are stored inaccessible to children. LPA observed there is a first aid kit inaccessible to children. LPA observed posted a menu with the snacks and food provided by the center. LPA observed the center is equipped with refrigerator, microwave oven and sink with running water in the snack preparation area. LPA observed the facility has a functioning smoke detector and a fire extinguisher type 2A10BC last serviced on June 2019. LPA observed that drinking water is readily available indoor via water fountain. LPA observed there are trash cans with tight fitting covers for the disposal of solid waste. LPA observed the center has at least one working Carbon Monoxide detector. Ms. Rodriguez states that there are no weapons in the premises. The outdoor areas are surrounded with appropriate fencing and not bodies of water. LPA observed that all furniture, equipment and playground equipment is safe and in good conditions, free of sharp, loose, or pointed parts. LPA observed that shade in the playgrounds is provided by trees. LPA observed that outdoors water is provided via portable cooler and disposable cups. LPA observed there is not climbing structures in the playground. LPA observed all floors were clean and safe. REPORT DATED 10/17/2019 CONTINUES ON PAGE #2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GABILAN HEAD START	FACILITY NUMBER: 270710358
	VISIT DATE: 10/17/2019

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
26
27
28
29
30
31
32

Report dated 10/17/2019 continues from page 1.

LPA observed that a fire drill was documented on 10/15/2019. LPA obtained a copy of the children's roster, and it is current. LPA reviewed a random sample of eight children's files and found in them the Emergency Information form. LPA reviewed the sign-in, sign-out sheets and are signed with full signatures. LPA observed there was a medical assessment document and a preadmission health history document in each child’s record. LPA observed there are records in each personnel file documenting the educational background of the staff.

Staff of the center has obtained criminal records clearance or exemptions thru the Monterey County Office of Education. LPA reminded Ms. Rodriguez of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12-month-period.
Ms. Rodriguez stated there are three children under medication currently enrolled in the center.
For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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.
LPA observed that all the staff has obtain proof of completion of the mandated reporter training AB1207. LPA referred Ms. Rodriguez to the Department website: www.ccld.ca.gov for additional information on the online training. LPA observed that all the staff members present today have proof of immunization for measles, pertussis and influenza in file in compliance with the SB792.

No deficiencies were cited during today's inspection. Exit interview was conducted with Ms. Rodriguez. LPA provided Ms. Rodriguez with the notice of site visit which has to be visible posted for the following 30 consecutive days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2