340314894-5-6-2022-03-CC-KGUA-CE6RVA-20220506132113

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340314894
Report Date: 05/06/2022
Date Signed: 05/06/2022 01:21:20 PM

Document Has Been Signed on 05/06/2022 01:21 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	COYLE AVE HEAD START & STATE PRESCHOOL		FACILITY NUMBER:	340314894
ADMINISTRATOR:	FASUYI, TERRI		FACILITY TYPE:	850
ADDRESS:	6330 COYLE AVE.		TELEPHONE:	(916) 979-8015
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	24	CENSUS: 15	DATE:	05/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Shannon SImpkins and Asma Al Khafaji		TIME COMPLETED:	01:30 PM

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At 11:25 a.m. on Friday, May 6th. 2022, Licensing Program Analyst (LPA) Karyn Guerra met with School Community Worker (Staff) Shannon Simpkins and Child Development Assistant (CDA) Asma Al Khafaji, for the purpose of an unannounced required - 1 year inspection. A risk assessment for COVID-19 was conducted. LPA observed a census of 15 preschool children supervised by 4 staff. Hours of operation for the program are from 8:30 a.m. - 3:00 p.m., Monday thru Friday. Program operates in classroom K2, and receives state funds.

Criminal record clearance is on file with San Juan Unified School District. Staff 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 conducted a health and safety inspection of the classrooms, restrooms, and food service areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat laws, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Staff stated that there are no firearms nor poisons on the premises. Fire Drills were conducted and documented at least once every 6 months.

The facility provides breakfast and lunch. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. Food in the facility was properly stored to prevent contamination. Drinking water is provided to children via labeled water bottles. LPA observed sign in and sign out logs with full legal signature of parent/guardians.

Report continued on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: COYLE AVE HEAD START & STATE PRESCHOOL	FACILITY NUMBER: 340314894
	VISIT DATE: 05/06/2022

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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 and 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 at: http://www.ada.gov/childqanda.htm.

LPA conducted a health and safety inspection of the outdoor space. Playground equipment and surfaces were free of loose or sharp parts. LPA observed wood chips to provide cushioning. Outdoor shade was provided by awnings and trees. Water is accessible via drinking fountain and labeled bottles.

LPA reviewed staff and children's records. Each child's file contained an admission agreement, emergency card, health history, immunization record, physician report, and acknowledgement of receipt for personal rights, consent for emergency medical treatment, and parent’s rights. LPA observed CPR and First past course enrollment for at least one staff on the facility premises. LPA advised to have printed certificate of completion in staff file. LPA observed health screening, staff immunization records and AB 1207 Mandated Reporter training certificates. LPA advised to ensure that Mandated Reporter training is current for all staff. LPA observed employee rights, and documentation of the educational background, training, and/or experience.

A staff interview was conducted with Shannon SImpkins.

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.

In the areas that were evaluated, no deficiencies were cited during today’s inspection. Exit interview conducted and report was reviewed with the CDA, Asma Al Khafaji. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn Guerra	TELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC809 (FAS) - (06/04)

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