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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270534
Report Date: 09/20/2019
Date Signed: 09/20/2019 04:06:58 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:FULLERTON HEAD STARTFACILITY NUMBER:
304270534
ADMINISTRATOR:KAREN MORRISSEYFACILITY TYPE:
850
ADDRESS:341 S. COURTNEY STREETTELEPHONE:
(714) 447-3005
CITY:FULLERTONSTATE: CAZIP CODE:
92834
CAPACITY:75CENSUS: 34DATE:
09/20/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Valerie Rivera, DirectorTIME COMPLETED:
04:10 PM
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An announced annual inspection was conducted by the Licensing Program Analyst (LPA) Torrence on 09/20/2019. During the inspection, LPA met with Director Valerie Rivera, who guided analyst on a tour of the Early Childhood Setting indoors and outdoors. The following census was taken: Room 2, four children, with two staff supervising, Room 3, 13 children, with two staff and three volunteers supervising, and Room 4, 17 children, with two staff supervising. Operation hours are 7:30 a.m. to 5:30 p.m. Monday through Friday. During this inspection, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratio. 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 clearance.

The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture were inspected to ensure it's in good condition, free of sharp, loose or pointed parts. Toilets and sinks were inspected to ensure they are safe and in a sanitary operating condition, floors were inspected for safety and cleanliness. This facility provides breakfast, lunch, and PM snacks. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material. Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements for (Measles, Pertussis, and Flu vaccines). Facility has a current disaster drill log. Facility have a current children's roster available. Fire extinguisher and carbon monoxide was located at this facility. A sample of children's files were reviewed.



Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov . Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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 2
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: FULLERTON HEAD START
FACILITY NUMBER: 304270534
VISIT DATE: 09/20/2019
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During this inspection, there was no deficiency cited per CA Code of Regulations Title 22.

Exit interview was conducted. Report reviewed and discussed. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. Notice of Site Visit was posted during the visit. Appeal rights provided and explained. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
LIC809 (FAS) - (06/04)
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