343623183-8-28-2019-03-CC-TWAN-BFGNS4-20190828104232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623183
Report Date: 08/28/2019
Date Signed: 08/28/2019 10:42:46 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 HIRAM JOHNSON HEAD START (INF)		FACILITY NUMBER:	343623183
ADMINISTRATOR:	GOMEZ, CARMEN		FACILITY TYPE:	830
ADDRESS:	3535 65TH STREET		TELEPHONE:	(916) 263-3800
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95820
CAPACITY:	6	CENSUS: 13	DATE:	08/28/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jose Diaz and Betsy Uda		TIME COMPLETED:	10:50 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Tanya Washington and Seychelle De Luca met with Facility Coordinator Jose Diaz and Head Start Program Officer Betsy Uda for the purpose of an announced pre-licensing change of ownership inspection. The facility has an emergency approval to operate issued by the Sacramento Regional Child Care Office. Upon arrival, LPAs observed 3 infants supervised by 2 staff and 10 toddlers supervised by 3 staff. Applicants request an infant license to serve 8 infants 0 to 24 months with a Toddler Option program to serve 32 toddlers from 18 months to 36 months. The program will operate Monday through Friday from 7:30 AM to 5:00 PM, year round. LPAs observed the following documents posted: Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, menus, and daily schedule. LPAs discussed the forms that must be in each child's and each staff member's file and LPAs provided LIC311A. Food will be prepared and delivered by SETA's central kitchen. The facility will be providing breakfast, lunch and snacks. LPAs advised Applicants that the Infants Needs and Service Plan must be updated quarterly. LPAs also discussed staffing qualifications and ratio/capacity regulations for an infant program with applicants. LPA also discussed the infant napping and supervision requirements as wells as Safe Sleep practices and SIDS. INDOOR ACTIVITY SPACE: There is one infant classroom (Classroom 1) and three toddler classrooms (Classroom 2, 3, and 4). LPAs observed sufficient amount of furniture and play equipment in all classrooms. There are seven cribs in the infant crib area to accommodate infants under 12 months of age. LPAs also observed cots for infants older than 12 months of age. There is a first aid kit in each of the classrooms. Medications will be stored in each of the classrooms in a locked box. LPAs observed cleaning disinfectants appropriately stored and inaccessible to children. Applicants stated there are no poisons on the premises. LPAs observed water fountains indoors that are accessible to children. LPAs observed a functional carbon monoxide detector in the crib area and in between Classrooms 3 and 4. LPAs observed an electronic sign-in/sign-out system. Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

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 HIRAM JOHNSON HEAD START (INF)	FACILITY NUMBER: 343623183
	VISIT DATE: 08/28/2019

NARRATIVE

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LPAs measured the classroom space. The total classroom space contains a total of 2410.92 square feet, which will accommodate Applicant's request for 40 children. There are two toilets and six sinks for the children and a separate private restroom for the staff. There are changing tables that are at least one inch thick with raised sides that are at least three inches high. The changing table for infants is located near the sink. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
The outdoor area is fully fenced by a iron rod fence which is at least four feet tall, additionally there is a small fence separating the infant and toddler yards. LPAs observed age appropriate play equipment. Applicant stated that they will use a water jug and paper cups for children's drinking water outside. There are no firearms or bodies of water on the premises. There is a shaded area supplied by an overhang and canopy.

The outdoor activity space was measured. The outdoor play area contains a total of 2110.01 square feet, which will not accommodate Applicant's request for 40 children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the facility file. Incidental Medical Services and a Plan of Operation is located in the facility file. 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.

Report continues on 809-C

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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 HIRAM JOHNSON HEAD START (INF)	FACILITY NUMBER: 343623183
	VISIT DATE: 08/28/2019

NARRATIVE

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LPAs discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; mandated reporter training and maintaining buildings and grounds.

This facility evaluation report was reviewed and discussed with the Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers. LPAs provided and discussed Safe Sleep in Child Care and Effects of Lead Exposure brochures.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:

1. A final review of the file by LPM Roxana Saravia.
2. Fire Clearance
3. Updated LIC 500 to reflect the current Administration
4. Orientation certificate for Director
5. Waiver request for a rotating shared playground use
6. Two potty chairs to accommodate the requirement of toileting
7. Copy of Needs and Services for infants and toddlers

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya Washington	TELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

LIC809 (FAS) - (06/04)

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