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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503608903
Report Date: 03/07/2022
Date Signed: 03/07/2022 02:29:35 PM


Document Has Been Signed on 03/07/2022 02:29 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:KEYES HEAD STARTFACILITY NUMBER:
503608903
ADMINISTRATOR:MCCORMICK, BRANDYFACILITY TYPE:
850
ADDRESS:4621 NUNES ROADTELEPHONE:
(209) 656-2388
CITY:TURLOCKSTATE: CAZIP CODE:
95382
CAPACITY:40CENSUS: 25DATE:
03/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Director - Brandy McCormickTIME COMPLETED:
02:40 PM
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On 03/07/2022, Licensing Program Analyst (LPA) Luisa Gavoutian, conducted an unannounced Annual Inspection. LPA met with Director, Brandy McCormick, who accompanied LPA on a tour of the facility, indoors and outdoors. This facility is located on the Keyes Elementary School campus. Hours of operation are Monday – Thursday, 8:00 a.m. – 3:00 p.m. and Fridays, 8:00 a.m. - 11:30 a.m.

All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. LPA observed accessible hand sanitizer in the following areas: on top of the cubbies in Room 2; on top of the tall water fountain in the large outdoor play area; in the lower cabinet of the portable sink located in the middle play yard. Director understands that hand sanitizer must be kept out of reach of children. No poisons were observed during the inspection.

Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

All meals and snacks are prepared in the school cafeteria and brought to the classroom for serving. All kitchen, food preparation, and storage areas are clean, free of litter/rubbish and rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. LPA observed one large garbage can outside of Room 2 that contained food waste and did not have a lid. Director stated that a lid shall be ordered. Uncontaminated drinking water is available both indoors and outdoors. Menus are posted at least one week in advance where an authorized representative can view them.
(Continued on LIC 809-C)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2022
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: KEYES HEAD START
FACILITY NUMBER: 503608903
VISIT DATE: 03/07/2022
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Playground equipment is in safe condition, free of sharp, loose, or pointed parts. Areas around high climbing equipment, swings, and slides have cushioning material in the form of poured rubber to absorb falls. LPA observed some plastic food wrapping debris near the storage shed in the larger outdoor play area; dried leaves between the parameter fence and the concrete of the middle play area; cobwebs underneath the picnic tables in the middle play area.

Facility representative 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.

Capacity and limitations as specified on the license are being maintained. At least one person trained in Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The person who signs the child in/out of the facility uses their full legal signature and records the time of day. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representatives or others who can assume responsibility if the authorized representative cannot be reached. Child 1 did not have a medical assessment on file. Child 2 did not have a risk assessment for tuberculosis performed by a licensed physician on file. LPA reviewed staff files and observed files were complete with immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training. Staff 1 did not have a copy of the health screening in the staff's records.

This facility provides Incidental Medical Services- 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. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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
(Continued on LIC 809-C)
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC809 (FAS) - (06/04)
Page: 6 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: KEYES HEAD START
FACILITY NUMBER: 503608903
VISIT DATE: 03/07/2022
NARRATIVE
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LPA and Director discussed the Community Care Licensing (CCL) website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies were observed today. Exit interview conducted and report was reviewed with the facility representative Brandy McCormick.

A notice of site visit was given and must remain posted for 30 days.



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 at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC809 (FAS) - (06/04)
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