444411594-4-11-2023-07-CC-ELAS-CQSV35-20230411160410

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444411594
Report Date: 04/11/2023
Date Signed: 04/11/2023 04:04:24 PM

Document Has Been Signed on 04/11/2023 04:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ENCOMPASS HEAD START		FACILITY NUMBER:	444411594
ADMINISTRATOR:	SUZANNA LOPEZ		FACILITY TYPE:	850
ADDRESS:	6500 SOQUEL DRIVE, BLDG. 1700		TELEPHONE:	(831) 477-5275
CITY:	APTOS	STATE: CA	ZIP CODE:	95003
CAPACITY:	28	CENSUS: 15	DATE:	04/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Arienya Simpson & Lorena Gonzalez		TIME COMPLETED:	04:05 PM

NARRATIVE

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Licensing Program Analyst (LPA) Elizabeth Larios conducted a unannounced Required-1 year inspection. LPA met with Site Supervisor, Arienya Simpson & Education Manager, Lorena Gonzalez and explained the nature of today's visit. LPA toured the facility both inside and outside during todays visit. LPA noted that the Facility is located on the Cabrillo College campus, in Building 1700 Classrooms 1 & 2. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. The hours of operation are Monday - Friday, 8:00am - 4:30pm.

LPA reviewed six children's and three staff files during today's visit. Each child's file reviewed contains the Information and Emergency Information form, immunization records, physicians report, personal rights, and parents rights. The Teacher Directors for each classroom file contain the required transcripts/verification of experience. The Teacher Directors and staff have current CPR and First Aid certifications on file. All staff have Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. All staff have completed the Mandated Reporter Training. The Teacher Directors in each classroom understand that there shall be at least one person with valid CPR and First Aid certifications on site at all times, or present during off-site activities.

The Teacher Directors understand the conditions, limitations, and capacity specifications of the facility license. The Teacher Directors understand that children shall be visually supervised at all times. LPA observed that room was clean and in order. Drinking water is readily available for the children in classrooms and in the outdoor playgrounds area via water dispensers and cups. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. The Site Supervisor stated that there are no weapons or firearms on the premises. CONTINUE ON LIC 809-C

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth Larios	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ENCOMPASS HEAD START	FACILITY NUMBER: 444411594
	VISIT DATE: 04/11/2023

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LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate. LPA did not observe any bodies of water.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food is prepared at the centralized kitchen, located at 2400 Grant Ave, San Leandro, CA 94580 and transported to facility each day. Cleaning supplies are securely stored and inaccessible to the children. LPA observed a fully charged 3A40BC fire extinguishers, and working smoke/carbon monoxide detectors. The Teacher Director stated that the facility does administer medications at this time.

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

Deficiency was cited, exit interview conducted with Site Supervisor, Arienya Simpson and a copy of this report was provided.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth Larios	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/11/2023 04:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ENCOMPASS HEAD START	FACILITY NUMBER: 444411594
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101170(e)(2)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth Larios	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC809 (FAS) - (06/04)

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