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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573600247
Report Date: 08/28/2019
Date Signed: 08/28/2019 04:48:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:WOODLAND MIGRANT HEAD STARTFACILITY NUMBER:
573600247
ADMINISTRATOR:LOPEZ, LIDIAFACILITY TYPE:
850
ADDRESS:39839 ROAD 17ATELEPHONE:
(530) 666-6452
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:76CENSUS: 27DATE:
08/28/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lidia Lopez, Center DirectorTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Charlotte Baney and Chayntel Hunter met with Center Director, Lidia Lopez for the purpose of an unannounced Annual/Random inspection. LPAs observed care and supervision of 27 preschoolers supervised by 5 staff. LPAs toured the facility inside and out. LPAs observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. Facility days and hours of operation are Monday-Friday from 5:00 AM to 5:00 PM from April until October.

LPAs reviewed care and supervision of children, staffing ratios, medications and first aid supplies, furniture, equipment, fire drills and drinking water. LPAs observed all required forms to be posted. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, there is sufficient cushioning under the play structure.

LPAs reviewed the electronic sign in/out tablet and observed that the children are properly signed in/out. LPAs observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. LPAs observed AB1207 mandated reporter training certificates for at least one staff. The Director was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

Incidental Medical Services (IMS) policy was discussed. Facility does not have any children that require an IMS plan.

A Title 22 DEFICIENCY was cited on the subsequent page LIC 809-D of this report. Appeals rights were discussed and printed. An exit interview was conducted. This facility evaluation report was reviewed and discussed with the Center Director. A Notice of Site Visit was posted.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: WOODLAND MIGRANT HEAD START
FACILITY NUMBER: 573600247
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2019
Section Cited

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All individuals subject to a criminal record review shall, prior to working, residing or volunteering in a licensed facility:
Request a transfer of a criminal record clearance.
This requirement was not met as evidenced by:
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LPAs observed one staff member that had fingerprint clearances but were not associated to the facility, and had not completed an exemption transfer request.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2019
LIC809 (FAS) - (06/04)
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