274400409-10-2-2019-07-CC-FCJO-BGKQA6-20191002115924

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274400409
Report Date: 10/02/2019
Date Signed: 10/02/2019 11:59:33 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:	PRIMAVERA MIGRANT HEAD START		FACILITY NUMBER:	274400409
ADMINISTRATOR:	WILLIAM CASTELLANOS		FACILITY TYPE:	850
ADDRESS:	24228 LINCOLN STREET		TELEPHONE:	(831) 679-0503
CITY:	CHUALAR	STATE: CA	ZIP CODE:	93925
CAPACITY:	45	CENSUS: 15	DATE:	10/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ethel Wilkinson		TIME COMPLETED:	12:10 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 Analysts (LPA), Fermin Campos-Jaramillo and Susy Cervantes made an unannounced annual random inspection to the center today. LPA met with Ethel Wilkinson, Site directors, and explained the nature of today's inspection to her. LPAs observed 15 children were in care today. LPA observed there were seven staff members taking care of the children. LPAs observed that at least one staff member present during the inspection has a current CPR/First Aid certifications. LPAs observed the teacher-child ratio was in compliance with regulations. LPAs observed posted the forms required by this Licensing Department. LPAs 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 March 2019. LPA observed that drinking water is readily available indoor via water dispensers and cups. LPA observed there are trash cans with tight fitting covers for the disposal of solid waste. LPA observed the center does not have a working Carbon Monoxide detector. Site Director 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 tarps. LPA observed that outdoors water is provided via water dispenser and disposable cups. LPA observed synthetic turf as resilient material under the climbing structure in the playground. LPA observed all floors were clean and safe. REPORT DATED 10/2/2019 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: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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

FACILITY NAME: PRIMAVERA MIGRANT HEAD START	FACILITY NUMBER: 274400409
	VISIT DATE: 10/02/2019

NARRATIVE

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Report dated 10/02/2019 continues from page 1.

LPA observed that a fire drill was documented on 8/16/2019. LPA obtained a copy of the children's roster, and it is current. LPA reviewed a random sample of ten 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.

A review of staff records on 9/30/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
LPA reminded Site Director 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.
Site Director stated there is only one child 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 the Licensee 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.

One type B deficiency was cited during today's inspection. Exit interview was conducted with Site Director.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: PRIMAVERA MIGRANT HEAD START	FACILITY NUMBER: 274400409
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/02/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/09/2019 Section Cited	1 2 3 4 5 6 7	Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This regulation was not met as evidenced by:
	8 9 10 11 12 13 14	LPAs observed the center does not have any working carbon monoxide detector installed today. Site Director understands this poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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