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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340317540
Report Date: 08/26/2024
Date Signed: 08/26/2024 11:11:00 AM

Document Has Been Signed on 08/26/2024 11:11 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DYER KELLY HEAD STARTFACILITY NUMBER:
340317540
ADMINISTRATOR/
DIRECTOR:		COSTA, SIMONAFACILITY TYPE:
850
ADDRESS:2236 EDISON AVENUETELEPHONE:
(916) 566-2151
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 19DATE:
08/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Fariba Ghulam SarwarTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kyrsten Williams met with Facility Representative, Fariba Ghulam Sarwar, for an unannounced annual inspection of this preschool facility. Census included 19 children being supervised by 4 staff. Facility is operating within the capacity and in compliance with staff child ratio on this day. Facility representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are 8:00 AM to 2:30 PM on Monday, Tuesday, Wednesday, and Friday and 8:00 AM to 11:45 AM on Thursdays. Program operates in classroom C113 and receives federal funds.

LPA conducted a health and safety inspection of the facility, including all activity and classroom spaces, restrooms, food service area, and outdoor play area. LPA observed the following documents are posted where visible to parents: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Classroom appeared clean, including the carpets and floor. The facility floor is in good repair and free of any hazards. The facility has age-appropriate furniture. The furniture is steady and in good repair. The play yard is free of hazards. All playground equipment and surfaces were inspected and are in good condition, with enough resilient material under climbing structures to absorb a fall. There are shaded areas for the children provided by an awning and the building. All toilets and hand washing facilities are in working condition with proper sanitation in place. Bins for solid waste have tight fitting lids. The facility provides breakfast and lunch. Food was properly stored to prevent contamination. Uncontaminated drinking water was readily available to children both indoors and outdoors via drinking fountains and cups. The building was constructed after January 1, 2010. All the cleaning solutions and other chemicals that are dangerous to the children are stored inaccessible to the children. LPA observed carbon monoxide detector, fire extinguisher, and first aid equipment. There is a working telephone at the site. There are no pools, spas or other bodies of water at the facility. There are no firearms or weapons on the premises. There are no poisons on the premises.

PAGE 1. REPORT CONTINUES ON LIC809-C
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DYER KELLY HEAD START
FACILITY NUMBER: 340317540
VISIT DATE: 08/26/2024
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LPA reviewed the UC 311A, Records to Be Maintained at The Facility, for child's records, personnel records, and administrative records. Children’s and staffs' files were reviewed. Each child's file had the required licensing documentation including emergency card, consent for emergency medical treatment, admission agreement, notification of children’s and parent’s rights, health history, physician’s report, and immunization records. LPA reviewed staff transcripts and observed all staff caring for children were qualified. Multiple staff have a current Pediatric CPR and First Aid certification. Staff all have current Mandated Reporter certificates and proof of immunization. LPA observed a current children's roster and a fire drill log. LPA observed that parents are signing their children in and out of the facility via electronic app.

Criminal record clearance is on file with San Juan Unified School District. The 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

In the areas that were evaluated, no deficiencies are cited today. Exit interview conducted and report was reviewed with the facility representative, Fariba Ghulam Sarwar. A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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