343623182-12-16-2021-03-CC-ATIY-C9RQSX-20211216112615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623182
Report Date: 12/16/2021
Date Signed: 12/16/2021 11:26:22 AM

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:	SETA BRET HARTE HEAD START		FACILITY NUMBER:	343623182
ADMINISTRATOR:	XAYAVONG, SAMANTHA		FACILITY TYPE:	850
ADDRESS:	2761 9TH AVENUE		TELEPHONE:	(916) 263-3800
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY:	48	CENSUS: 16	DATE:	12/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Samantha Xayavong		TIME COMPLETED:	11:45 AM

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Licensing Program Analyst (LPA) Alize Tillery met with Director Samantha Xayavong and Program Officer Linda De La Mora for the purpose of an unannounced required 1 year annual inspection. Upon arrival, LPA observed 3 toddler children supervised by 2 staff, and 13 preschool children, supervised by 3 staff. The facility hours of operation are Monday through Friday from 7:30 AM to 5:00 PM.

LPAs toured all activity and classroom spaces (classrooms: Preschool Room 1 and Early Head Start Room), the restrooms and outdoor play area. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, and daily schedule. Cleaning disinfectants, medications and hazardous items are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary and operating condition. LPAs suggested that the classroom rugs be vacuumed and deep cleaned, and licensees were reminded to keep bedding sheets separate and labeled. The program provides breakfast, lunch and one snack.

Drinking water is readily available to children both indoors and outdoors. Director stated that there is a water pitcher that is used and children use their personal cups. LPAs observed the facility’s electronic sign in and out sheet, menu and schedule. Playground equipment and surfaces are free of loose or sharp parts. There are sufficient equipment and toys. There are shaded areas supplied by the building. LPA recommended overhangs over the play structure during the Summer time.

Report continues on 809-C.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: SETA BRET HARTE HEAD START	FACILITY NUMBER: 343623182
	VISIT DATE: 12/16/2021

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6 staff and 10 children's records were reviewed. Each child's file was observed to be complete. LPA observed the children’s roster and advised the Director to add a column that includes the child’s physician name and contact number. Facility fire drills are up current, as the last drill was conducted on 12/2/2021. LPA observed complete staff files and reminded director that all staff Mandated Reporter trainings are to be completed every 2 years. At least one staff member present today has a current Pediatric CPR and First Aid certification that expires in 2023. LPAs reminded Director that 100% supervision is required at all times. LPAs observed a functional carbon monoxide detector, smoke detector and fire extinguisher. LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.

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.

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 is 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

Director 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.

During today’s inspection no deficiencies were cited. A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Director, Samantha and Program Officer Linda Da La Mora.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize Tillery	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC809 (FAS) - (06/04)

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