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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340314894
Report Date: 05/09/2023
Date Signed: 05/09/2023 12:09:43 PM


Document Has Been Signed on 05/09/2023 12:09 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 PRESCHOOLFACILITY NUMBER:
340314894
ADMINISTRATOR:GLASS, JESIKAFACILITY TYPE:
850
ADDRESS:6330 COYLE AVE.TELEPHONE:
(916) 979-8015
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:24CENSUS: 16DATE:
05/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jesika GlassTIME COMPLETED:
12:20 PM
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On May 9, 2023 at approximately 11:00 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Director Jesika Glass for the purpose of an unannounced annual random inspection. LPA observed care and supervision of 16 preschool children by 5 staff. The facility has a maximum capacity of 24. The facility hours of operation are Monday through Friday from 8:30 AM to 3:00 PM.

LPA toured the classroom, restrooms, cafeteria, and outdoor play area. Director stated there are no firearms on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts and the ground below the play structure is sufficiently padded. Restrooms are in sanitary condition with functioning toilets. The floors were clean throughout the facility.

LPA observed that solid waste containers were covered. Per Director, the facility provides breakfast and lunch daily, prepared in the cafeteria. Cafeteria food was refrigerated and labeled according to regulation. Drinking water was readily available to children both indoors and outdoors. LPA observed an electronic sign in and out sheet which showed all children present.

All present staff files were reviewed and found to be complete. LPA observed current Mandated Reporter certificate which will expire July 31, 2023 and current CPR and First Aid certificate which will expire April 7, 2024. LPA observed a fire drill log last updated February 7, 2023.

LPA observed the sample of children’s files contained the appropriate documents. LPA observed first aid equipment, functioning smoke and carbon monoxide detectors, and a fully charged fire extinguisher meeting regulation. Required documents were posted.

Report continues on LIC809-C…

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023
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: 05/09/2023
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LPA discussed 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

Facility Director was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.

No deficiencies were cited based on today’s inspection. Exit interview was conducted and report was reviewed with the Director. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah GathingTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC809 (FAS) - (06/04)
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