493009283-8-13-2019-01-CC-ASTR-BEZQT8-20190813122642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493009283
Report Date: 08/13/2019
Date Signed: 08/13/2019 12:26:50 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 JR		FACILITY NUMBER:	493009283
ADMINISTRATOR:	GROCOTT, LISA		FACILITY TYPE:	850
ADDRESS:	1336 TEMPLE STREET		TELEPHONE:	(707) 528-0803
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95404
CAPACITY:	20	CENSUS: 0	DATE:	08/13/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Lisa Grocott and David Ragen		TIME COMPLETED:	12:40 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 announced case management inspection was conducted at the facility by Licensing Program Analyst (LPA), Amy Strother in response to an application received on 06/21/19, requesting to add a toddler option. LPA Strother met with Head Start Director, Lisa Grocott and Head Start Support Services Manager, David Ragen, The center is currently licensed with a capacity of 20 preschool children, the Corporation is requesting to add a toddler option of 8 children, ages 18-36 months, adding to the number of preschool children, ages 3-5 years, for a total capacity of 28. A Fire Clearance for the requested capacity and structural changes made to the facility was granted on 08/12/19. Separation of age groups is accomplished by a wall down the center of the room, with a swinging door allowing access to the bathroom. The toddlers will be using one side of the room, titled Early Head Start and the preschoolers will be using the other side of the room, titled Head Start. The Corporation is requesting a waiver for shared use of the bathroom with the condition that toddlers will be accompanied by a Primary Caregiver Teacher when toilet training begins. A waiver has been approved for the shared use of the bathroom. A copy of the waiver will remain posted in a prominent location. There is one sink in the toddler room and two sinks and two toilets in the bathroom. There is a changing table with a hand washing sink within arms reach, meeting Title 22 requirements. The children will nap on cots covered with a fitted sheet, each child has a cot assigned to them for personal use. Personal belongings are stored in individual bags with the cots. The toddlers outdoor play yard will be separate from the preschool children. The program is achieving temporary separation from the section of the play yard with the climbing structure with the use of a plastic play yard fence zip tied to the chain link fencing and six orange construction cones. The Program Director understands the the toddlers may not use the area of the playground that includes the climbing structure since the age rating on the climber is for children ages 2 years and up. The Program Director will take a photo of how the play yard fence and the cones should be placed when the toddlers use the play yard so the the staff understand how to attain separation from the climbing structure. The Corporation has a work over in to have a permanent 8 foot fence with an 8 foot swinging gate to attain separation of the toddler yard. Continued 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: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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 - MARTIN LUTHER KING JR	FACILITY NUMBER: 493009283
	VISIT DATE: 08/13/2019

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The Program Director will take photos of the permanent fence and gate once the work order is complete and submit them to the department. The playground was free of hazards. The playground equipment and surface areas were in safe condition. The play yard is shaded by awnings over the sand area. Water will be provided for toddlers outside by disposable cups and a water jug.

This report was read and reviewed with Director, Lisa Grocott. All licensing reports are public information and must be made available upon request. The Director understands that written permission from each child's authorized representative to be placed in the toddler program must be kept in each child's file. The application to add a toddler option to the existing preschool license is approved and effective today, 08/13/19.

Notice of Site Visit shall be posted for 30 days from today’s visit.

There were no Title 22 deficiencies cited during today's visit.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy Strother	TELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

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