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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009283
Report Date: 05/03/2019
Date Signed: 05/03/2019 02:15:29 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 - MARTIN LUTHER KING JRFACILITY NUMBER:
493009283
ADMINISTRATOR:GROCOTT, LISAFACILITY TYPE:
850
ADDRESS:1336 TEMPLE STREETTELEPHONE:
(707) 528-0803
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY:20CENSUS: 0DATE:
05/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Carolina Menjivar and Carla BrusseauTIME COMPLETED:
02:30 PM
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A 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. At approximately 1:25 p.m. LPA Strother spoke to Administrative Services Assistant, Elizabeth Price from Community Action Partnership Sonoma County, who confirmed that all staff are currently fingerprint cleared and associated to the Lincoln Head Start Center. Elizabeth stated that she is in the process of working on having all Head Start staff associated to all of the Head Start facilities.

The facility’s operating hours are 8:00 a.m. to 4:00 p.m., Monday-Friday. Lead Teacher, Carolina Menjivar stated that the facility does not provide care for children on most Fridays, only a few throughout the year. Carolina stated that Fridays are used for cleaning the classroom, planning curriculum and staff meetings. LPA Strother requested a calendar of the Fridays that the facility will be providing care. 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, although no children were present during today's inspection. Carolina stated that no poisons are stored on the premise 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 with 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 the climbing structure to absorb falls.
Continue on LIC809-C
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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 - MARTIN LUTHER KING JR
FACILITY NUMBER: 493009283
VISIT DATE: 05/03/2019
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 LPA advised Carolina to make sure staff are moving the woodchips from under the platform and the corners of the yard into the fall and landing zones on a regular basis. There were no bodies of water observed. Carolina stated no weapons are stored on site and none were observed. During today's inspection, no children were present. Four staff were present and available to aide in the facility tour. The facility was operating within the licensed capacity. At least one staff member present during the visit possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Two children’s records were reviewed at 12:47 p.m., and contained signed admission agreements. One staff record was reviewed at 1:35 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 Carolina Menjivar and Carla Brusseau. (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 Carolina Menjivar and Carla Brusseau . 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 HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2