343623991-8-24-2021-03-CC-MLOR-C67QJM-20210824121258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623991
Report Date: 08/24/2021
Date Signed: 08/24/2021 12:13:08 PM

Document Has Been Signed on 08/24/2021 12:13 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	SETA DUDLEY HEAD START		FACILITY NUMBER:	343623991
ADMINISTRATOR:	BHAVNEET KAUR		FACILITY TYPE:	850
ADDRESS:	8000 AZTEC WAY		TELEPHONE:	(916) 263-3737
CITY:	ANTELOPE	STATE: CA	ZIP CODE:	95843
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/24/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Betsy Uda and Jose Diaz		TIME COMPLETED:	12:20 PM

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	Application Specialist (AS) Mai Lor met with Applicant Betsy Uda and Facility Coordinator Jose Diaz for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 20 preschool children from age two to entry into kindergarten. The facility is located on an Dudley Elementary school and operates in room J1. The program will operate Monday through Friday from 8:00 AM to 4:00 PM. The fire clearance was granted on 8/13/21. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, Effects of Lead Exposure, car seat poster, menus, and daily schedule. AS Lor provided and discussed LIC311A and the forms that must be in each child's and each staff member's file. AS Lor discussed new lead testing requirement and previously emailed PIN 21-21 (Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370) to the applicant prior to this inspection. Food will be prepared and delivered by SETA's central kitchen. The facility will be providing breakfast, lunch and snacks. INDOOR ACTIVITY SPACE: There is one preschool classroom: Classroom #1. AS Lor observed a sufficient number of tables, chairs, cubbies, and napping cots for 20 preschool children. AS Lor observed a variety of age-appropriate toys and equipment. There is a first aid kit in the classroom. Medications will be stored in the in a locked cabinet. Applicant stated cleaning disinfectants will be stored inaccessible to children. Applicant stated there are no poisons or firearms on the premises. AS Lor observed a water cooler which will be used for indoor and outdoor drinking water. AS Lor observed functional carbon monoxide detectors throughout the classroom. AS Lor observed an electronic sign-in/sign-out system. Report continues on 809-C.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: SETA DUDLEY HEAD START	FACILITY NUMBER: 343623991
	VISIT DATE: 08/24/2021

NARRATIVE

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AS Lor measured the classroom. The total classroom space contains a total of 1384.349 square feet, which accommodates Applicant's request for 20 preschool children. There are two toilets and three sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property for preschool children which will be shared with the Dudley Elementary School children. A shared playground waiver request was submitted and the waiver was granted. Approved waiver was provided to the Applicant and copy will be placed in the facility file. The outdoor play area is fenced with chained link fence that is four feet tall. AS Lor observed a variety of age-appropriate outdoor toys and equipment. The play structure includes a safety label, which designates use for children 2 to 5 years old. AS Lor observed bark beneath the structure. AS Lor reminded Applicant that barks will need to be replaced when they become low. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

AS Lor measured the outdoor activity space. The outdoor play area contains a total of 5151.692 square feet, which accommodates Applicant's request for 20 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the preschool file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/(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.

Report continues on 809-C.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: SETA DUDLEY HEAD START	FACILITY NUMBER: 343623991
	VISIT DATE: 08/24/2021

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Report continues on 809-C.

AS Lor discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS Lor discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility evaluation report was reviewed and discussed with Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

COVID-19 technical assistance and support was previously conducted prior to this inspection. COVID-19 technical assistance and support was reviewed again with the Applicant and Facility Coordinator.

Prior to licensure, the application is pending Licensing Program Manager’s final file review.

Exit interview conducted.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Mai Lor
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021

LIC809 (FAS) - (06/04)

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