274400200-9-3-2021-07-CC-SCES-C6HQ67-20210903115305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274400200
Report Date: 09/03/2021
Date Signed: 09/03/2021 11:53:11 AM

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:	VALLE VERDE MIGRANT HEAD START		FACILITY NUMBER:	274400200
ADMINISTRATOR:	TRUJILLO, MARTHA		FACILITY TYPE:	850
ADDRESS:	490 EL CAMINO REAL		TELEPHONE:	(831) 674-0290
CITY:	GREENFIELD	STATE: CA	ZIP CODE:	93927
CAPACITY:	76	CENSUS: 31	DATE:	09/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Martha Trujillo		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	On 09/03/2021 at 9:50 AM, Licensing Program Analyst (LPA), Susy Cervantes, conducted an annual visit to the Facility today. LPA met with Martha Trujillo, director, 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, and Activity Schedule. A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 09/01/2021 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA also reminded them of the applicable civil penalties for those adults who have not received fingerprint clearance, 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. 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 3 staff files. All 3 staff have current CPR and First Aid Certifications on file expiring 02/22 and 08/22. Director 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). Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. LPA reviewed the sign-in, sign-out sheets for the past 30 days and Child Care Facility Roster (LIC 9040) and all were in compliance. *Continues on report dated 09/03/2021 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: 09/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

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: VALLE VERDE MIGRANT HEAD START	FACILITY NUMBER: 274400200
	VISIT DATE: 09/03/2021

NARRATIVE

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Continuation of report dated 09/03/2021 pg. 1/2

LPA observed that the teacher/child ratio was in compliance during today’s visit. LPA observed 3 teacher with 8 children in Room 1, 3 teachers with 6 children in Room 2, 3 teacher with 9 children in Room 3, and 2 teachers with 8 children in Room 4 during today’s visit.

LPA observed that all rooms are clean and safe for all children and staff. Drinking water is readily available for the children in each room and in the outdoor playground area via water dispensers. LPA observed solid waste containers with tight-fitting lids in each room and in the playground areas. 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. Director states that there are no weapons on the premises.

The food is prepared and delivered to the facility from Soledad MSHS in Soledad, CA. Cleaning supplies are inaccessible to the children. Any medications at the Facility are stored appropriately in each classroom. LPA reviewed the Facility’s medicine log and medication lock box during today’s visit.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground areas utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is also sufficient resilient materials (type: grass and pour and play rubber) in the outdoor playground area. LPA did not observe any bodies of water.

LPA discussed Zero Tolerance with $500 civil penalty and the requirements of AB633 with the director, Martha Trujillo, and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and they understand the requirements. Licensing Forms, Title 22 Regulations and Information can be obtained through the internet at www.cdss.ca.gov.

LPA conducted an exit interview with the director. No deficiencies were 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: 09/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021

LIC809 (FAS) - (06/04)

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