566212166-3-5-2020-17-CC-BCES-BMERT7-20200305121753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566212166
Report Date: 03/05/2020
Date Signed: 03/05/2020 12:17:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CDR - RIO ROASLES HEAD START		FACILITY NUMBER:	566212166
ADMINISTRATOR:	SUZANNE GODINEZ		FACILITY TYPE:	850
ADDRESS:	1001 KOHALA ST.		TELEPHONE:	(805) 278-2313
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY:	46	CENSUS: 35	DATE:	03/05/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Darlene Goodrich		TIME COMPLETED:	11:00 AM

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 March 5, 2020 at 9:00 AM, Licensing Program Analyst (LPA) Betzayra Cervantes made an unannounced visit to conduct an Annual/Random inspection. LPA met with Site Supervisor Darlene Goodrich and discussed the nature and purpose of the visit and together a tour of the facility was conducted both inside and outside. There was total of 35 children under the care and supervision of 6 teachers including the Site Supervisor. There are a total of two classrooms, "G" and "F", located on the school grounds of Rio Rosales Elementary School. The center currently operates from August to June, 8:00 AM to 2:00 PM Monday through Friday. The classrooms were observed free of hazards and all classrooms are equipped with age appropriate toys, teaching materials, and furnishings for children in care. Teachers escort children to the elementary school campus bathrooms which were observed clean and sanitary. Waste containers have tight-fitting covers. The playground is fenced with appropriate shading and was observed in good condition and free of hazards. The areas around or under high climbing equipment have cushioned material. No bodies of water were observed on the premises. There is drinking water readily available for children inside and outside the classrooms. The facility provides breakfast, lunch and snack for children in care. Menus were posted prominently on the wall along with the site's facility license and Emergency Disaster Plan. Sign in/out sheets were reviewed and found complete. All staff have a criminal record clearance. Staff records are located at the CDR Human Resource Office and will be reviewed at a later date. A sampling of children records were reviewed and LPA observed Admissions Agreement and Identification and Emergency Notification forms on file. CPR and First Aid cards are current with an expiration date of 08/06/2020. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CDR - RIO ROASLES HEAD START	FACILITY NUMBER: 566212166
	VISIT DATE: 03/05/2020

NARRATIVE

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Effects of Lead Exposure pamphlet and Provider Information Notice (PIN 20-01-CCP) was provided and discussed with Site Supervisor.

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 Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

No deficiencies were cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020

LIC809 (FAS) - (06/04)

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