270710358-10-6-2021-07-CC-SCES-C7JTA9-20211006143309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 270710358
Report Date: 10/06/2021
Date Signed: 10/06/2021 02:33:15 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:	24	CENSUS: 10	DATE:	10/06/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Raquel Rodriguez		TIME COMPLETED:	02:40 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	On 10/06/2021 at 12:55 PM, Licensing Program Analyst (LPA), Susy Cervantes, conducted an annual visit to the facility and met with Raquel Rodriguez, master teacher, and explained the nature of today’s visit. LPA toured the Facility both inside and outside during today’s visit. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents’ Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus (includes current and following week), and Activity Schedule. All facility staff are fingerprinted and cleared by the Monterey County Office of Education (MCOE). LPA observed the medical assessment and the Information and Emergency Information form (LIC 700) in 5 children’s files. LPA observed the required health screening in 2 staff files. Master teacher has current CPR and First Aid Certifications that expire 08/07/23. Master teacher understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Master teacher understands the conditions, limitations, and capacity specifications of the Facility license. Master teacher understands that children shall be visually supervised at all times. LPA reviewed the sign-in, sign-out on a tablet for the past 30 days and took pictures of a Child Care Facility Roster (LIC 9040) and all were in compliance. LPA observed that the teacher/child ratio was in compliance during today’s visit. LPA observed 2 teachers with 10 children during today’s visit. Drinking water is readily available for the children in each room and in the outdoor playground area via drinking fountains with cups and water dispensers. LPA observed solid waste containers with tight-fitting lids in each room and in the playground area. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Master teacher stated there are no weapons on the premises. Continues on report dated 10/06/2021 pg. 1/2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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

FACILITY NAME: GABILAN HEAD START	FACILITY NUMBER: 270710358
	VISIT DATE: 10/06/2021

NARRATIVE

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Continuation of report dated 10/06/2021 pg. 2/2

Food is delivered daily from the MCOE central office in Salinas. The food preparation area is adequately equipped with warmer, refrigerator, and hot and cold running water. Cleaning supplies are inaccessible to the children and stored in the kitchen. Medications at the Facility are stored appropriately and in a locked medical cabinet in the classroom that is out of reach for the children. LPA reviewed the Facility’s medicine log and medication lock box during today’s visit.

LPA observed a disaster drill log that was last conducted on 10/06/2021. Smoke detector and carbon monoxide detector are operable. LPA observed a 2A10BC fire extinguisher that was last serviced on 06/17/2021.

LPA observed all furniture and equipment are in operable condition. The playground area utilized by children is surrounded by appropriate fencing. LPA observed that the outdoor equipment is age appropriate and in good condition. There is also sufficient resilient material, grass, in the outdoor playground area. LPA did not observe any bodies of water.

LPA discussed the requirements of AB 633 with master teacher, Raquel Rodriguez, and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and they understand the requirements. LPA also discussed "zero tolerance" related regulations with the master teacher and was advised of the assessment for an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. Licensing Forms, Title 22 Regulations and Information can be obtained through the internet at www.cdss.ca.gov.

LPA conducted an exit interview with Master teacher, Raquel Rodriguez.
No deficiencies cited during today's visit. NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC809 (FAS) - (06/04)

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