493007752-9-3-2019-01-CC-ASTR-BFNUFF-20190903153241

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493007752
Report Date: 09/03/2019
Date Signed: 09/03/2019 03:32:47 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 - J X WILSON		FACILITY NUMBER:	493007752
ADMINISTRATOR:	NUNEZ RUIZ, SANDRA		FACILITY TYPE:	850
ADDRESS:	246 BRITTAIN LANE		TELEPHONE:	(707) 544-6911
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY:	20	CENSUS: 0	DATE:	09/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Christina Ambrosini		TIME COMPLETED:	03:45 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. 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 Head Start. LPA arrived to the facility, and was greeted by Staff 1 (S1), who stated that the facility typically runs a morning and afternoon program, but currently only has children enrolled in the morning program, so no children were present during today's inspection. S1 called Area Supervisor, Christina Amrosini to inform her of the visit from LPA. Christina arrived at the facility to facilitate the inspection. The program runs from mid-August to mid-May, closed June and July. The facility’s operating hours are 7:45 a.m.-11:45 a.m. for the morning session, Monday-Thursday, and when the afternoon program is running, operates from 12:00 p.m.-4:00 p.m. 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. S1 stated that no poisons are stored on the premises and none were observed during today's inspection. The toys, floors, tables 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. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. S1 stated no weapons are stored on site and none were observed. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications. 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: 09/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

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: HEAD START - J X WILSON	FACILITY NUMBER: 493007752
	VISIT DATE: 09/03/2019

NARRATIVE

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The sign-in/sign-out procedure was reviewed and in compliance. Seven children’s records were reviewed at 2:30 p.m., and contained signed admission agreements. Two staff records were reviewed at 2:55 p.m. and contained documentation of education and training as required. This facility is providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Area Supervisor. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the Area Supervisor. 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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019

LIC809 (FAS) - (06/04)

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