483002943-11-16-2022-01-CC-KOCL-CL8U4U-20221116141542

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483002943
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:15:52 PM

Document Has Been Signed on 11/16/2022 02:15 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	HEAD START - MARIPOSA		FACILITY NUMBER:	483002943
ADMINISTRATOR:	ESCOBAR, DIEGO		FACILITY TYPE:	850
ADDRESS:	1625 ALAMO DRIVE		TELEPHONE:	(707) 387-6561
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	44	CENSUS: 9	DATE:	11/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Maria Valdez, Director		TIME COMPLETED:	02:25 PM

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 required inspection was made to the facility by Licensing Program Analyst (LPA), Kevin O'Connell. The facility file was reviewed prior to this inspection. This is a Title 5 Program. Criminal Record Clearance is provided by the Department of Education. The Director 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. The facility’s operating hours are 08:00am- 04:00pm, Monday – Friday. 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. The Director states that there are no poisons but can be key locked in a back yard shed if needed. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. The children’s bathrooms were in safe and sanitary condition. Children are provided breakfast, lunch and snacks, menus were posted. Food prep areas are clean. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is "Pour and Play" and bark chips underneath climbing structures and/or play equipment to absorb falls. The LPA observed a working carbon monoxide detector and a charged fire extinguisher of at least 2A 10: BC or larger. The Director stated that there are no bodies of water and none were observed. The Director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met as there were 9 children being supervised by four staff. The facility was operating within the licensed capacity. Sign in, sign out regulation was reviewed, discussed and in compliance.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HEAD START - MARIPOSA	FACILITY NUMBER: 483002943
	VISIT DATE: 11/16/2022

NARRATIVE

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At least one staff member present during the visit possessed current Pediatric CPR and First Aid certifications. Four staff records were reviewed at 01:00 pm. Nine children’s records were reviewed at 01:25pm, and contained identification forms with authorized representative information, as well as medical assessments.

Incidental Medical Services (IMS) policy was discussed. This facility provides Incidental Medical Services (inhalers, Epi-pens)– 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

No title 22 regulations were cited today. A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted and report was reviewed with the Center Director, Maria Valdez.

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:

www.cdss.ca.gov/inforesources/communty-care-licensing/process.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'Connell	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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