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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173000114
Report Date: 08/09/2023
Date Signed: 08/14/2023 08:42:48 AM

Document Has Been Signed on 08/14/2023 08:42 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NCO HEAD START - PEARL CENTERFACILITY NUMBER:
173000114
ADMINISTRATOR:MEDEROS, JODYFACILITY TYPE:
850
ADDRESS:14521 PEARL AVE.TELEPHONE:
(707) 994-6045
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY: 17TOTAL ENROLLED CHILDREN: 17CENSUS: 0DATE:
08/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Site Supervisor, Jody MederosTIME COMPLETED:
11:15 AM
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A required one-year inspection was made to the facility by Licensing Program Analysts (LPA), Sebastian Phouthavong. LPA met with Site Supervisor, Jody Mederos. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff have received criminal record and child abuse index clearances or exemptions. facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During today's inspection, the facility was in the process of getting ready for operation and plans to provide care later this month. The facility’s operating hours are 08:00am-12:00pm, Mondays – Friday and was toured inside and outside; the floor and yard plan submitted by the licensee were verified. Sign in/out records were reviewed and in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. There are no poisons in the facility, and none were observed during this inspection. LPA observed the toys, floors, desks and other equipment and surfaces are clean, toxic free, safe, and in good condition. There is uncontaminated drinking water available to children indoors and outdoors using water jug and individual drinking cups. The children's bathrooms are in safe and sanitary condition. The center’s isolation area for any child who becomes ill while in care is located in the staff office or parent room. LPA observed food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. Menus are posted in the entry of the school. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. LPA observed the playground to be in the process of getting updated. There were no bodies of water observed on the site. No weapons are stored on site, and none were observed.

Continued on LIC 809-C.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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