493005171-9-6-2019-01-CC-ASTR-BFRTC2-20190906143602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493005171
Report Date: 09/06/2019
Date Signed: 09/06/2019 02:36:11 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:	R.L. STEVENS HEAD START CENTER		FACILITY NUMBER:	493005171
ADMINISTRATOR:	GROCOTT, LISA		FACILITY TYPE:	850
ADDRESS:	2345 GIFFEN AVENUE		TELEPHONE:	(707) 545-5340
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95407
CAPACITY:	20	CENSUS: 0	DATE:	09/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Ashley Castillo		TIME COMPLETED:	02:55 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 random inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. LPA met with Interim Director, Ashley Castillo. During today's inspection, no children were present, LPA was informed that the children attend Monday-Thursday. Present at the facility were four staff, Staff 1-4 (S1-S4). The facility file was reviewed prior to this visit.This program is operated by Head Start. A review of the personnel report on file indicates that not all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Upon record review Staff 3 (S3) does not have a criminal record clearance association to Head Start Lincoln, the central file for all Head Start staff or any other Head Start facility. Records indicate that S3 does however currently have an active criminal record clearance. Executive Director, Lisa Grocott joined the inspection at 1:15 p.m. to review the records on file for S3. LPA printed forms and discussed a plan of correction with Grocott. The facility’s operating days and hours with staff are Monday-Friday, 7:30am-4:30pm,. The facility's operating days and hours with children are Monday-Thursday, 8:00am-12:00pm for the morning session and 12:15pm-4:15pm for the afternoon session. The facility is open mid-August through late May, closed all of June and July. 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. Director stated that no poisons are stored on the premises and none were observed during today's inspection. 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 provided by a water jug and disposable paper 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. Continue on LIC809-C

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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

FACILITY NAME: R.L. STEVENS HEAD START CENTER	FACILITY NUMBER: 493005171
	VISIT DATE: 09/06/2019

NARRATIVE

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There is wood chip cushioning and grass on the playground to absorb falls. The facility does not have a climbing structure. There were no bodies of water observed. The Director stated no weapons are stored on site and none were observed. At least one staff member present during the visit (S3) possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Seven children’s records were reviewed at 11:45 a.m., and contained signed admission agreements. Three staff records were reviewed at 12:20 p.m. 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, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochure, were 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.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

An exit interview was conducted and Plans of corrections were reviewed and developed with the Lisa Grocott. Appeal Rights were provided and discussed with, Ashley Castillo, whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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: R.L. STEVENS HEAD START CENTER	FACILITY NUMBER: 493005171
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/16/2019 Section Cited	1 2 3 4 5 6 7	(e)All individuals subject to a criminal record review...Health and Safety Code Section 1596.871 shall prior to working, ...in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on record review and interview, the licensee failed to maintain a California clearance or a criminal record exemption as required by the Department for S3, which poses a potential Health, Safety, or Personal Rights risk to the children in care.	8 9 10 11 12 13 14	Grocott will also review and update the procedures to ensure that all staff remain associated to the central file, Head Start Lincoln, and compare the LIC500 to the facility personnel report summary annually.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

LIC809 (FAS) - (06/04)

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