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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623183
Report Date: 10/07/2021
Date Signed: 10/07/2021 12:13:02 PM

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:GEETA SINGFACILITY TYPE:
830
ADDRESS:3535 65TH STREETTELEPHONE:
(916) 263-3800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:40CENSUS: 16DATE:
10/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Geeta SinghTIME COMPLETED:
11:00 AM
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On Thursday, October 7, 2021 at 9:00 AM, Licensing Program Analysts (LPAs) Tanya Washington and Jeremey McClain conducted an unannounced annual random inspection for the infant/ toddler program. LPAs met with Facility Representative Geeta Singh. Upon arrival, LPAs observed 16 toddlers supervised by eight staff members in three different classrooms. Operating hours are Monday thru Friday from 8:00 AM to 4:00 PM. Facility Representative indicated that they currently do not provide care to infants under 18 months and only care for children 18 months and above. Facility Representative also indicated that they plan to refurnish the previous infant room and turn it into another toddler room. LPA advised FP to contact licensing prior to making alterations.

LPAs conducted a health and safety inspection inside and outside of the facility. There are two separate play yards for infant and toddler children. Infant furniture and equipment, including cots and mats are sufficient, age appropriate and in good repair. Infant changing table has a padded surface no less than one inch thick, covered with washable vinyl or plastic, and has raised sides at least three inches high. Toys are safe, without sharp points, edges, splinters or small parts that can be pulled off and swallowed. Facility is in compliance with staff infant ratios.

Feeding plans, Needs and Services plans, and Infant Sleep logs are in clompliance. Sign in/out is completed on a digital keypad. Staff utilized as infant teachers have three child development units in infant/toddler care. Firearms and ammunition are not on the premises. Facility Representative acknowledged that storage area for poisons needs to be locked and stated that there are no poisons on site. Disinfectants, hazardous items and medications are inaccessible to children. Rooms are safe and clean. All staff subject to a criminal record clearance or exemption are associated to the centralized facility #340313658- Bannon Creek. Emergency information reviewed for some children. Staff records reviewed contain documentation of the educational background, training, and/or experience and, a Health Screening/TB test and immunization records to meet SB 792.

REPORT CONTINUED ON LIC809C
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: 10/07/2021
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LPAs observed a current fire drill log. LPAs observed current CPR and First Aid certification for at least one staff present during the inspection. LPAs also observed Mandated Reporter training for staff caring for children today.

Outdoor area for children appeared clean and safe for use. Facility representative stated that they provide children with a sippy cup indoors and single use paper cups outdoors.

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 discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Report continued on LIC809C

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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: 10/07/2021
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Facility representative 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.

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 Title 22 deficiencies were observed. Exit interview conducted and report was reviewed with the facility representative Geeta Singh. A notice of site visit was given and must remain posted for 30 day

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Tanya WashingtonTELEPHONE: 916-879-1209
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3