451304969-9-26-2019-13-CC-PPAO-BGDMRQ-20190926095044

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 451304969
Report Date: 09/26/2019
Date Signed: 09/26/2019 09:50:52 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	SHASTA HEAD START - BURNEY		FACILITY NUMBER:	451304969
ADMINISTRATOR:	PFADT, TANAKA		FACILITY TYPE:	850
ADDRESS:	38234 HWY 299E		TELEPHONE:	(530) 335-2415
CITY:	BURNEY	STATE: CA	ZIP CODE:	96013
CAPACITY:	24	CENSUS: 17	DATE:	09/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Tanaka Pfadt		TIME COMPLETED:	09:55 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	An annual inspection was conducted at the facility by Licensing Program Analysts (LPA), Emilia Grisak and Patricia Pacheco. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This program is operated by Shasta Head Start and is a Title 5 funded program. The facility’s operating hours are 8:30 am - 2:30 pm, Monday - Friday and closes during the summer months. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Poisons are locked in a cabinet in the restroom and a detached shed. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors via water pitcher and cups. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. There are two wall heaters in the facility that both have secure screens around them to prevent the children from accessing them. The director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met, and 17 children were being supervised by four teachers/aides. The facility was operating within the licensed capacity. At least one staff member

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Patricia Pacheco	TELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: SHASTA HEAD START - BURNEY	FACILITY NUMBER: 451304969
	VISIT DATE: 09/26/2019

NARRATIVE

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present during the visit (S1) possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Ten children’s records were reviewed at 9:35 am, and contained signed admission agreements. Three staff records were reviewed at 9:30 am and contained documentation of education and training as required. This facility is not currently providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the director. 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: www.ada.gov/childqanda.htm. This report was reviewed and discussed with the director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Patricia Pacheco	TELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

LIC809 (FAS) - (06/04)

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