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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 535401182
Report Date: 02/07/2020
Date Signed: 02/07/2020 10:11:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SHASTA HEAD START - WEAVERVILLEFACILITY NUMBER:
535401182
ADMINISTRATOR:BLACKWELL, JILLIANFACILITY TYPE:
850
ADDRESS:216 TRINITY LAKETELEPHONE:
(530) 623-4110
CITY:WEAVERVILLESTATE: CAZIP CODE:
96093
CAPACITY:24CENSUS: 10DATE:
02/07/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jillian BlackwellTIME COMPLETED:
10:10 AM
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An annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. 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. The facility’s operating hours are 8:30 am-12:30 pm, Monday - Friday. The program follows a partial school schedule and is closed in the summer.

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 under kitchen sink, the kitchen is gated and the cabinet has a lock and in the staff bathroom under sink which is locked . Poisons are not kept on site per Site Supervisor. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water is available to children both indoors and outdoors via water foundations and at meal times via pitchers of water and cups are provided. The children's bathrooms are in safe and sanitary condition. A current menu was posted in classroom. Food prep areas are clean. Food is properly stored and refrigerated as needed. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas are in safe condition. There is rubberized playground cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The Site Supervisor stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and ten children were being supervised by three teachers/aides. The facility was operating within the licensed capacity.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie WisehartTELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SHASTA HEAD START - WEAVERVILLE
FACILITY NUMBER: 535401182
VISIT DATE: 02/07/2020
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At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications (expires 9/21/21). The facilities last Fire Drill was conducted on 1/6/20 and is done within every six months. Ten children’s records were reviewed at 9:29 am, and contained identification forms with authorized representative information. Staff records were reviewed at 9:42 am, and contained documentation of education and training, as required. This facility is providing Incidental Medical Services (IMS). The Department’s Incidental Medical Services (IMS) policy was discussed with the Site 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 brochure and the Provider Notice and Flyer for Lead Exposure testing, were reviewed and discussed with the Site 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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie WisehartTELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2020
LIC809 (FAS) - (06/04)
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