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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 325407786
Report Date: 09/29/2021
Date Signed: 09/29/2021 01:28:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:QUINCY HEAD STARTFACILITY NUMBER:
325407786
ADMINISTRATOR:TOLEN, LEASAFACILITY TYPE:
850
ADDRESS:175 NORTH MILL CREEK ROADTELEPHONE:
(530) 283-0592
CITY:QUINCYSTATE: CAZIP CODE:
95971
CAPACITY:24CENSUS: 10DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Site Supervisor, Leasa TolenTIME COMPLETED:
01:30 PM
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On 9/29/2021 at 11:00am, an annual inspection was made to the facility by Licensing Program Analysts (LPA), Kirk Marks and Bianca Mendez. This program is operated by Head Start. The facility operating hours are 7:45 - 1:45, Monday–Friday. The facility was toured at 11:35 inside and outside and the floor and yard plan submitted by the licensee were verified. Facility operates in one classroom on part of the campus of Pioneer Elementary School.

Four staff members were supervising 10 children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises.

11 children's records were reviewed at 11:50. Four staff records were reviewed at 11:05.

Site Supervisor 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.

Incidental Medical Services (IMS) policy was discussed. 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

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk MarksTELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: QUINCY HEAD START
FACILITY NUMBER: 325407786
VISIT DATE: 09/29/2021
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There were no deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Site Supervisor, Leasa Tolen.

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.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk MarksTELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
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