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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001191
Report Date: 01/06/2020
Date Signed: 01/06/2020 11:53:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:HEAD START - VIRGINIAFACILITY NUMBER:
483001191
ADMINISTRATOR:L.SMITH,J.EDWARDS,G.GARROTFACILITY TYPE:
850
ADDRESS:1328 VIRGINIATELEPHONE:
(707) 974-8756
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:37CENSUS: 29DATE:
01/06/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Latissa SmithTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Melchisedeck Augustin made an unannounced inspection at the facility to follow up on an unusual incident that occurred on 09/04/19, involving a neighbor who exhibited threatening behavior. The incident took place off site and did not impact the children in care. LPA met with Director Latissa Smith and LPA discussed the purpose of the inspection with the Director. LPA discussed with the Director, the protocol for staff to follow in case an emergency, staff training requirements, reporting requirements, methods to enhance security and ways to ensure the safety of children and staff. The facility's last disaster drill was conducted in joint coordination with the Solano Sheriff on the 12/1719. The facility acknowledges and agrees to notify parents about all unusual incidents in a timely manner and the facility will continue to implement the plan discussed.


This report was reviewed and discussed with the Director. Notice of Site Visit shall be posted for 30 days from today’s inspection. There were no Title 22 deficiencies cited during today’s inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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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