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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621111
Report Date: 12/05/2019
Date Signed: 12/05/2019 01:31:29 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:SANTA FE - SUSD HEAD STARTFACILITY NUMBER:
393621111
ADMINISTRATOR:KELLER, DEBRAFACILITY TYPE:
850
ADDRESS:639 W. WORTH STREETTELEPHONE:
(209) 463-1355
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:20CENSUS: 0DATE:
12/05/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ana Garza-MartinTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Fabiola Diaz and Seychelle De Luca met with Site Supervisor Ana Garza-Martin for the purpose of an unannounced required three year inspection. Site Supervisor was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday from 8:00 AM to 11:30 AM and the program follows the school calendar. The facility is located inside the gated Santa Fe Town Homes complex. No children were present during today's inspection. LPA Diaz will return to observe care and supervision.

During today's inspection, LPAs took measurements indoors and outdoors. The total indoor square footage is 740.811 square feet, which accommodates the current capacity of 20 children. The total outdoor square footage is 1,141.53 square feet, which accommodates a maximum of 15 children. Site Supervisor understands the facility needs to provide a waiver request for a rotating schedule where no more than 15 children are outside at one time.

LPAs toured all activity and classroom spaces, restrooms, kitchen, and outdoor play areas. Currently, no preschool children require medications. Site Supervisor stated there are no poisons 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. The areas around or under climbing equipment are cushioned with bark to absorb the fall. The climbing structure has a safety label that indicates use for children from age two to five years old. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides breakfast. Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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: SANTA FE - SUSD HEAD START
FACILITY NUMBER: 393621111
VISIT DATE: 12/05/2019
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Menus were posted and drinking water was readily available to children both indoors and outdoors. LPAs observed full legal signatures while reviewing the sign in and sign out sheet as required for preschool age component.

Two staff and three children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 5/5/2020). All staff currently employed with the facility have a criminal record clearance through the school district, health screening report, and documentation of the educational background, training, and/or experience. LPAs reminded Site Supervisor that 100% supervision is required at all times, including in the bathroom. There are no firearms or bodies of water on the premises. LPAs observed a functional carbon monoxide detector that Site Supervisor stated is hardwired into the fire alarm system. LPAs 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 10 working days.

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.

This facility evaluation report was reviewed and discussed with Site Supervisor. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Site Supervisor 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 child care centers. In the areas that were evaluated, no deficiencies were observed at the time of the visit.

SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2