274415141-6-13-2022-07-CC-SCES-CFCVJJ-20220613162848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274415141
Report Date: 06/13/2022
Date Signed: 06/13/2022 04:28:56 PM

Document Has Been Signed on 06/13/2022 04:28 PM - It Cannot Be Edited

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:	SANTA LUCIA MIGRANT SEASONAL HEAD START		FACILITY NUMBER:	274415141
ADMINISTRATOR:	WILLIAM CASTELLANOS		FACILITY TYPE:	850
ADDRESS:	618 WALNUT AVENUE		TELEPHONE:	(831) 674-5725
CITY:	GREENFIELD	STATE: CA	ZIP CODE:	93927
CAPACITY:	72	CENSUS: 28	DATE:	06/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Norma Melo		TIME COMPLETED:	04:35 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 06/13/2022 at 11:30 AM, Licensing Program Analyst (LPA), Susy Cervantes met with director, Norma Melo for an annual inspection and explained the nature of today's visit. Director informed LPA they have a doctor's appointment and will be leaving before closing and appointed office staff, Dolores Ramirez, to sign and receive report. 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 06/09/2022 was reviewed; and it indicates that not all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA reviewed 10 children's and 12 staff files during today's visit. Children's file's had all required documents complete and in compliance. LPA observed staff 03 is missing LIC 9052. Staff 01, 02, 03, 04, 07, 09, 10, 11, and 12 have current CPR and First Aid certifications on file. 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. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. *Continues on report dated 06/13/2022 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: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

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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Document Has Been Signed on 06/13/2022 04:28 PM - It Cannot Be Edited

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: SANTA LUCIA MIGRANT SEASONAL HEAD START	FACILITY NUMBER: 274415141
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(l)(1)(B)

Personnel Requirements

(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which staff 05 does not have LIC 9052 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/27/2022
	Plan of Correction
1 2 3 4	Director will provide LIC 9052 to staff 05 to be completed and will submit a copy of the completed form to the San Jose Regional Office by close of business on June 27, 2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

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: SANTA LUCIA MIGRANT SEASONAL HEAD START	FACILITY NUMBER: 274415141
	VISIT DATE: 06/13/2022

NARRATIVE

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Continuation of report dated 06/13/2022 pg. 2/2

LPA observed 3 teacher with 14 children in section 1, 2 teachers with 4 children in section 2, 1 teacher with 4 children in section 3, 1 teacher with 3 children in section 4, and 1 teacher with 3 children in section 5, teacher/child ratio was in compliance 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 pitchers and disposable cups. LPA observed solid waste containers with tight-fitting lids in each room. 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 or firearms on the premises.

Food is prepared and brought from Little Angels in King City, storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Any poisons are stored in the locked storage cabinet, located near the kitchen area. Medications at the Facility are stored in the director's office refrigerator or in the classroom.

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 sufficient resilient materials (type: grass) in the outdoor playground area. LPA did not observe any bodies of water.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Type B deficiency was cited during today's visit. Exit interview conducted and report was reviewed with the facility representative, Dolores Ramirez. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Susy Cervantes	TELEPHONE: (408) 598-9403
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

LIC809 (FAS) - (06/04)

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