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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603968
Report Date: 10/18/2019
Date Signed: 10/18/2019 12:30:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MATT KLINE HEADSTARTFACILITY NUMBER:
300603968
ADMINISTRATOR:HERNANDEZ, WENDOLINFACILITY TYPE:
850
ADDRESS:2043 MEYER PLACETELEPHONE:
(949) 548-4480
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:60CENSUS: 52DATE:
10/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director Hernandez Wendoline TIME COMPLETED:
12:30 PM
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An unannounced Annual/ Random inspection was conducted on this date by Licensing Program Analyst (LPA) Ketki Desai . Upon arrival, LPA was greeted by Director Ms. Hernandez Wendoline at the Head start portable office, Education Manager Ms Rose Alvarez shortly joined and accompanied the LPA on a tour of the facility. The Head Start program here offers a Full day and a half day programs with AM/PM sessions in the assigned three classrooms (Room # 2 and 3 : Full day program and Room # 4: Half day sessions.
A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearances. All staff are cleared are associated to the central facility (Matt Kline).

Census: Room #1: (Full day session) 17 children with 2 teachers and one assistant
Room # 2:(Full day session) 16 children with 2 teacher and 1 assistant
Room # 3 ( Half day AM Session) 19 children with 1 teacher and 1 assistant

The Center's days and hours of operation are Monday- Friday 7.30 to 5.30
AM session : 8.00 am to 11.30 / PM session: 12.30 PM to 4.00 PM .

Posting requirements: All posting requirements were observed on the Parent Boards. The license, the snack and lunch menu, the Personal Rights, Child Passenger Safety Law, Notification of Parents Rights, Emergency disaster plan are posted on the Parent Board.

Physical Plant: Facility designee guided LPA on a tour of the facility, All the three classrooms were observed, Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating and air-conditioning, lighting and ventilation were evaluated. Storage for children's belongings and toilets were inspected. The restroom is located in the hallway and is used by all the three rooms ( 6 stalls and 6 sinks)
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MATT KLINE HEADSTART
FACILITY NUMBER: 300603968
VISIT DATE: 10/18/2019
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Transportation: This facility does not provide transportation services

An Emergency Disaster Drill log is posted. The last fire drill was ran 10-17- 2019 and Earthquake drill on 10-17-19 . Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met appropriately. Sign in and out sheets and procedures were reviewed with Director as was the policy of checking children for illnesses. Children are sign in / out by parents upon arrival and later during pick up time. Personal Rights of children were discussed and observed by LPA. Per Director, there are currently no firearms or weapons on the premises.


File review: A random sampling of 9 preschoolers' files and five staff files were reviewed for completeness, including, but not limited to Criminal Record Clearances for adults, qualifications and verification of CPR/First Aid for the openers and closers. All the files are kept in the main office . Emergency cards are available for review. Staff present on premises are current on Infant CPR/ First Aid along with Immunization's and Mandated Reporting training.

No deficiency cited per title 22 on today's inspection.

Upon receipt, Administrator Hernandez Wendolin posted the Notice of Site Visit.

The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Director.

Appeal Rights provided and explained to the Director.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MATT KLINE HEADSTART
FACILITY NUMBER: 300603968
VISIT DATE: 10/18/2019
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If a child is ill, they are brought into the Director's office and mat with linens are brought out for the child. Availability of drinking water was reviewed , each classroom was observed to have a Water pitcher with small cups and during outdoor activities water fountain was observed in the play yard..
There is a Fire extinguisher, smoke carbon monoxide detector mounted on the wall it was tested and is operable.

Play Yard: All the three Preschool classrooms use the same yard on the premises. Each room has a separate exit door leading to the yard. Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. There is concrete and shaded area on the playground, Water fountain observed. The playground is surrounded on all four sides by a five foot high metal fence. The play area was inspected for hazards and inaccessibility to bodies of water. The toys are stored in the locked shed.

Food Service: The Center serves Breakfast / Lunch and PM snacks for full day sessions.
AM - Half day session receive Breakfast and Lunch while PM Half day session receive Lunch and PM snack. Food is served in a Family style dining and it is catered through Great America Lunch Box company. Teacher warm up the food as needed in the classroom Microwave. Kitchen staff brings in the required kitchen utensils. Monthly menu is posted.

Napping: Children attending the full day sessions nap in the classroom. Mats are labelled and are stored appropriately. Linens are provided by the center and are also washed on premises by the attending staff.

Health related Services: There is one First Aid Kit in each classroom hung near the exit doors. Director and staff are trained by Health Educators who provide the needed IMS treatment to the child. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173

101226. 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 athttp://www.ada.gov/childqanda.htm www.ada.gov/childqanda.html.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
LIC809 (FAS) - (06/04)
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