243810148-8-12-2021-04-CC-JMOA-C5TUZL-20210812160143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 243810148
Report Date: 08/12/2021
Date Signed: 08/12/2021 04:01:47 PM

Document Has Been Signed on 08/12/2021 04:01 PM - 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:	GRASSLANDS HEAD START		FACILITY NUMBER:	243810148
ADMINISTRATOR:	FLORES, MELANIE		FACILITY TYPE:	850
ADDRESS:	1951 MISSION DR		TELEPHONE:	(209) 381-5170
CITY:	LOS BANOS	STATE: CA	ZIP CODE:	93635
CAPACITY: 80	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/12/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Melanie Flores		TIME COMPLETED:	12:45 PM

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On 08/12/2021, Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an announced Prelicensing inspection and met with Assistant Director, Monica Garza, Site Supervisor, Melanie Flores, & Education Manager, Paula Smith. LPA explained the reason of the inspection and a tour of the center was conducted both inside and outside. The center is located on the premises of Grasslands Elementary School on 1951 Mission Drive in Los Banos, CA. The licensee is requesting a preschool license with a capacity of 80 preschool children. This program will operate on a traditional school year schedule from Monday through Friday 8:00 AM to 3:30 PM. The classrooms utilized are labeled Number #1, #2, #3, and #4 which are divided into 3 buildings - counting the office.

Breakfast, lunch, and one snack are provided by the centralized kitchen (Westside Head Start) and brought over to the preschool. Monica stated that a staff brings the food into classrooms. Ill children and staff will utilize the staff bathroom located each building and office building. Ill children will be isolated in the Site Supervisors office. The cleaning supplies will be stored in high locked cabinets located in the children's bathrooms. LPA also observed room #1 & #3 to have a washer and dryer in the children's bathroom. LPA Reminded Melanie to make sure staff have supervision of children at all times when using the restroom. Melanie stated that the bedding and sheets will be washed on site every week- Friday, or whenever necessary.

All four classrooms were observed to be clean and free of toxins. LPA observed that the Furniture and equipment appeared to be safe and in good condition and there were plenty of storage space for children's belongings. The cots will be stored in each classroom and LPA observed plenty of tables, chairs, and age appropriate toys. There is a refrigerator, dish washer, and Microwave in each classroom. There is a latch on the refrigerator so children don't have access to it. Melanie stated that staff will visually supervise children at all times so children wont have access to the dishwasher or microwave that's on top of the counter. A working carbon monoxide is installed in each classroom.

Continued on next page LIC 809-C

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Juvenal Moctezuma
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: GRASSLANDS HEAD START	FACILITY NUMBER: 243810148
	VISIT DATE: 08/12/2021

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Melanie stated that she will have a sanitation table in right outside of each classroom where parents can sign their child in/out and stated that staff will do wellness checks every morning during drop off and take the children's and staffs temperatures every day.

Room measurements were taken and reviewed with Licensee. The total inside preschool area measured to an approximate 3,498 square feet which will accommodate 80 preschool children. There are a total of 12 toilets and 20 sinks/hand washing fixtures available to children which will accommodate the requested capacity of 80 preschool children. There are water faucets available in each classroom but due to Covid Melanie stated that they will have water jugs with disposable cups for children to use both indoor and outdoor.

The approximate outside square footage for the preschool area is 3,976 which will only accommodate 53 preschool children at a time. Monica stated that no more than 40 children will be outside playing at the same time. A waiver request has been submitted and pending approval. The preschool play area is gated all around. There are 4 exit doors that have a push bar. LPA reminded licensee to have visual supervision of children at all times so they don't get out. LPA observed a bike path area with age appropriate toys (bikes), plenty of grass, a sand box with a flower bed, and a shade structure. Their are two sheds for storage which will remain closed and locked at all times. LPA reminded Melanie to provide adequate supervision at all times.

A fire clearance for 80 preschool children is still pending.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes 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

he following items must be completed prior to issuing a license by 08/20/2021.

Report Continued Onto LIC 809-C

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Juvenal Moctezuma
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: GRASSLANDS HEAD START	FACILITY NUMBER: 243810148
	VISIT DATE: 08/12/2021

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Inside Day-care:

· Disposable Cup Dispenser

· Fire Clearance
· Waiver for playground
· Get Latches for outdoor play yard gate
· Fix children's toilet in classroom #1
· Sand box cover

Pending a final file review and completion of above items, a recommendation will be made to license the above facility for a capacity of 80 preschool children.

The following documents should be posted at the facility:

* PUB 269- Child passenger restraint systems poster 101225(f) Transportation

* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)
* Activity Schedule
* Lead Poisoning brochure

No deficiencies cited during today's visit.
A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov

SUPERVISORS NAME: Michael Duarte
LICENSING EVALUATOR NAME: Juvenal Moctezuma
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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