503808604-3-25-2022-04-CC-SGAN-CCUPP3-20220325112852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503808604
Report Date: 03/24/2022
Date Signed: 03/25/2022 11:28:58 AM

Document Has Been Signed on 03/25/2022 11:28 AM - 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:	MUNCY EARLY HEAD START		FACILITY NUMBER:	503808604
ADMINISTRATOR:	HOTCHKISS, JEWELEE		FACILITY TYPE:	830
ADDRESS:	2410 JANNA AVENUE		TELEPHONE:	(209) 238-0572
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	48	CENSUS: 25	DATE:	03/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Shawnda Pombo, Master Teacher		TIME COMPLETED:	12:00 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	On 3/24/2022, Licensing Program Analyst (LPA) Stefanie Galvan conducted an unannounced Annual Inspection for the infant license. LPA met with Master Teacher, Shawnda Pombo, and toured the facility indoors and outdoors. This facility maintains a toddler component for children and is conducted in a space that is conducted in areas physically separate from those used by older or younger children. This is a full day program that operates from 7:30am to 5:30pm year-round. 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 four infants in care. 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. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. 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. Floors in the facility are clean and safe. The facility is free of flies, insects and rodents. There is a working carbon monoxide detector. The facility has sufficient age appropriate furniture, and equipment including cribs, cots or mats, changing tables and feeding chairs. The facility has indoor activity space for infants that is physically separate from space used by preschool childcare center/school-age childcare center components. Continued on 809-C

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Stefanie Galvan	TELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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: MUNCY EARLY HEAD START	FACILITY NUMBER: 503808604
	VISIT DATE: 03/24/2022

NARRATIVE

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Playground equipment is in safe condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA observed sufficient cushioning material in the form of grass underneath high climbing equipment.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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. Solid waste storage containers have tight-fitting covers and are in good repair. 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.

All staff is background cleared by Stanislaus Office of Education prior to being admitted for employment. Capacity and limitations as specified on the license are being maintained. 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 four infants in care. At least one person trained in Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The name of the childcare center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out uses their full legal signature and records the time of day.

Continued on 809-C

SUPERVISOR'S NAME: Alice Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Stefanie Galvan	TELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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: MUNCY EARLY HEAD START	FACILITY NUMBER: 503808604
	VISIT DATE: 03/24/2022

NARRATIVE

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LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and/or others who can assume responsibility if the authorized representative cannot be reached. All children’s files were complete with a medical assessment, individual feeding plan, and Infant Needs and Services Plan. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and documentation of completed mandated reporter training. Staff records contain documentation of meeting qualification requirements.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the CCL website (www.ccld.ca.gov) which provides access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed today.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and report was reviewed with facility representative Shawnda Pombo

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 Juarez	TELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Stefanie Galvan	TELEPHONE: (559) 341-5431
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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