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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623185
Report Date: 08/08/2019
Date Signed: 08/08/2019 10:21:31 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 CP HUNTINGTON HEAD STARTFACILITY NUMBER:
343623185
ADMINISTRATOR:CHERIA DANIELSFACILITY TYPE:
850
ADDRESS:5917 26TH STREETTELEPHONE:
(916) 263-3800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY:28CENSUS: 11DATE:
08/08/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Jose Diaz and Betsy UdaTIME COMPLETED:
10:30 AM
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Licensing Program Analysts (LPAs) Mai Lor 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. Upon arrival, LPAs observed 11 preschool children supervised by two staff. Applicants request a preschool license to serve 20 preschool children from three to five years of age with a Toddler Option program to serve eight toddlers from 18 months to 36 months. The program will operate Monday through Friday from 7:00 AM to 5:00 PM.

Applicants acknowledge that the following documents must be posted at all times: License, 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.

INDOOR ACTIVITY SPACE:
There is one preschool classroom (Classroom 1) and one toddler classroom (Classroom 2). In the preschool classroom, LPAs observed 5 tables, 32 chairs, 32 cubbies, and 25 napping cots. In the toddler room, LPAs observed 19 chairs, 5 tables, 10 cubbies, and 8 napping cots. 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 both indoor and outdoor that will be accessible to children. LPAs observed a functional carbon monoxide detector in each classroom. LPAs observed an electronic sign-in/sign-out system.

Report continues on 809-C.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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 CP HUNTINGTON HEAD START
FACILITY NUMBER: 343623185
VISIT DATE: 08/08/2019
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LPAs measured the classroom space. The total classroom space contains a total of 2498.093 square feet, which will accommodate Applicant's request for 28 children. There are four toilets and eight sinks for the children and a separate private restroom for the staff. 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:
There is one main outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall. There is a play structure on the playground with a safety label indicating age limitation for children ages 2 to 5 years old and adult supervision is recommended. Applicants acknowledge that children under 2 years old will not be able to use the play structure. 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 8554.587 square feet, which will accommodate Applicant's request for 28 children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). LPAs

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 SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC809 (FAS) - (06/04)
Page: 2 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 CP HUNTINGTON HEAD START
FACILITY NUMBER: 343623185
VISIT DATE: 08/08/2019
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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; staff to children ratios and capacity; staff qualifications; 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.

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 200A, LIC 308, LIC 610, LIC 500 to reflect the current Administration
4. Orientation certificate for Director
5. Waiver request for a rotating shared playground use
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3