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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475408065
Report Date: 05/13/2022
Date Signed: 05/16/2022 01:45:48 PM

Document Has Been Signed on 05/16/2022 01:45 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SHASTA HEAD START CHILD DEVELOPMENT,INC-WEED CTRFACILITY NUMBER:
475408065
ADMINISTRATOR:FERGUSON, APRILFACILITY TYPE:
850
ADDRESS:575 WHITE AVE CLASSROOM 1TELEPHONE:
(530) 241-1036
CITY:WEEDSTATE: CAZIP CODE:
96094
CAPACITY: 16TOTAL ENROLLED CHILDREN: 13CENSUS: 0DATE:
05/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tessa Buell and Sarah BogenerTIME COMPLETED:
12:15 PM
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A prelicensing inspection was conducted today at 10:30 a.m. by Licensing Program Analyst (LPA), N. Cunningham. LPA met with Child Development Manager Tessa Buell and Area Manager, Sarah Bogener. The applicant is requesting a license for 16 preschool age children. The facility will operate January – December, Monday-Friday, 7:30 a.m. to 2:30 p.m. The facility has one classroom (room #1) and one bathroom for children and one bathroom for staff in the staff break room.

The indoor and outdoor activity spaces were toured, and the facility sketch was verified. Meals will be prepared at the Mt. Shasta facility and transported to the facility. Children will nap on cots in the classroom. The isolation area for sick children will be located in the office area. The changing area will be on a mat close to the bathroom.

The outdoor play area is fully fenced. There is a play structure for children to play on and adequate cushioning underneath. There is no pool, spa, pond, fountain, or any other body of water on the premises. There is safe and age appropriate furniture, toys, and play equipment available for children.

A capacity worksheet was completed during the visit. There is enough indoor space for 23 children. There is one toilet and two sinks available for children.

LPA reviewed the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SHASTA HEAD START CHILD DEVELOPMENT,INC-WEED CTR
FACILITY NUMBER: 475408065
VISIT DATE: 05/13/2022
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Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant/licensee/facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant/licensee/facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following items need to be completed prior to the granting of license:
1. Receipt of approved fire clearance on form STD850
2. Picture of fence installed in the outdoor area
3. Complete the Emergency Disaster Plan

Exit interview conducted and report was reviewed with the Child Development Manager, Tessa Buell and Area Manager, Sarah Bogener.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
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