483002019-11-12-2021-01-CC-EHTS-C8Q237-20211112160152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483002019
Report Date: 11/12/2021
Date Signed: 11/12/2021 04:02:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	HEAD START - TABOR		FACILITY NUMBER:	483002019
ADMINISTRATOR:	MC CAFFREY, KRISTIN		FACILITY TYPE:	850
ADDRESS:	83 TABOR AVENUE		TELEPHONE:	(707) 427-6133
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	44	CENSUS: 6	DATE:	11/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Laarnie Noces Lead Teacher		TIME COMPLETED:	04:15 PM

NARRATIVE

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A required inspection was conducted today by Licensing Program Analysts (LPAs) Melchisedeck Augustin and Elpidia Hernandez Torres. The entire inspection was not completed today, as facility did not furnish staff records and a continuation visit to review personnel records will be conducted at a later time. At 10:49 AM LPAs reviewed ten children's records. Records reviewed revealed a child ( C2.3), immunization record was not transcribed onto the CDPH 286. The following deficiencies were issued during todays inspection see 809-D.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative. Appeal rights were provided.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres	TELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: HEAD START - TABOR	FACILITY NUMBER: 483002019
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/12/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on children's record review at 10:49AM, the facility did not comply with the section cited above. C2.3 immunization record is not transcribed on the blue CDPH. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/26/2021
	Plan of Correction
1 2 3 4	Lead teacher stated the children's files will be reviewed to ensure all documentation is properly transcribed when needed. LPA stated she will give the child's name so at the continuation visit the record will be reviewed to ensure the CDPH 286 has been appropriately completed. POC will be submited by 11/26/2021

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: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres	TELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC809 (FAS) - (06/04)

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