483009363-2-14-2023-01-CC-EHTS-CP356Q-20230214184107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483009363
Report Date: 02/14/2023
Date Signed: 02/14/2023 06:41:18 PM

Document Has Been Signed on 02/14/2023 06:41 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	HEAD START - KIDDER - INFANT/TODDLER		FACILITY NUMBER:	483009363
ADMINISTRATOR:	VASQUEZ, JESSICA		FACILITY TYPE:	830
ADDRESS:	1657 KIDDER AVENUE		TELEPHONE:	(707) 758-9159
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 7	CENSUS: 5	DATE:	02/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Acting Center Director Lupe Miron		TIME COMPLETED:	06:50 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	An annual inspection was made to the facility by Licensing Program Analyst (LPA), Elpidia Hernandez Torres. The facility file was reviewed prior to this inspection. A review of the personnel report on 02/14/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This program is operated by Head Start. The facility’s operating hours are 08:00AM- 04:00PM, Monday – Thursday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. The regulation that, Poisons are locked with a key or combination lock was reviewed. The acting center director stated poisons are not kept on the premises. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors through the use of water coolers. The children’s bathrooms were in safe and sanitary condition. A current menu was posted on the classroom window. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is turff cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The acting center director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were five children being supervised by three teachers. The facility was operating within the licensed capacity. At least one staff member present during the visit possessed current CPR and First Aid certifications. Six children’s records were reviewed, and contained identification forms with authorized representative information, as well as medical assessments. Six staff records were reviewed, and contained health screening forms. The sign in/out procedure was reviewed and in compliance. Continued on 809-C

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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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Document Has Been Signed on 02/14/2023 06:41 PM - It Cannot Be Edited

Created By: Elpidia Hernandez Torres On 02/14/2023 at 06:04 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HEAD START - KIDDER - INFANT/TODDLER	FACILITY NUMBER: 483009363
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(C)

Responsibility for Providing Care and Supervision for Infants

(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, observation and staff interviews five infants were missing their name, and/or date, and/or initial, and/or time of each 15 miniute check and observations. The licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2023
	Plan of Correction
1 2 3 4	LPA Hernandez Torres reviewed safe sleep regulations with Acting center director, infant lead teacher and additional teacher from the infant license. LPA will reach out to acting center director on 02/28/2023 and ask Center director for the sleep log for the week of 02/20/2023 for two infants at random. Acting center director agreed to submit the sleep log for the two infants on or before 03/01/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Leslie Lepori

LICENSING EVALUATOR NAME:

Elpidia Hernandez Torres

LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: HEAD START - KIDDER - INFANT/TODDLER	FACILITY NUMBER: 483009363
	VISIT DATE: 02/14/2023

NARRATIVE

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The Infants sleep logs were reviewed and not in compliance with regulation a deficiency was cited on 809-D. Licensee was reminded that all adults 18 and over, 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 licensee 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 licensee 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.

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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Acting Center Director.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

LIC809 (FAS) - (06/04)

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