<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009680
Report Date: 04/29/2024
Date Signed: 04/29/2024 11:43:33 AM

Document Has Been Signed on 04/29/2024 11:43 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HEAD START - SETTERQUISTFACILITY NUMBER:
483009680
ADMINISTRATOR/
DIRECTOR:
TAYLOR, ANGELINAFACILITY TYPE:
850
ADDRESS:300 STANFORD DRIVETELEPHONE:
(707) 645-8372
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 13DATE:
04/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Angelina TaylorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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
Licensing Program Analyst (LPA) Glenn Ouye met with Site Supervisor Angelina Taylor and a teacher.
LPA arrived to meet with the Site Supervisor regarding an incident which occurred on February 22 2024 in which child C1 had an allergic food reaction on that day after the lunch meal.

The meal service safety plan for C1 is as follows: C1 has a list of know food allergies. Child C1 has a separate Menu which is posted in the kitchen on the refrigerator along with a list of known food allergies. The food is produced and packaged by a food vendor named Trio Community Meals. The meals are sealed individually to prevent cross contamination. Teacher will verify items in the meal and match the special menu before heating the food and before serving. Child's food is limited to only what is on the menu. A teacher sits with the children who have the food allergies so food from other children does not cross contaminate their food. After the children eat, the children use the bathroom and take a nap. The children with allergies are also checked on during napping to see if there are any reactions. Teacher (T1) indicated that seasoned chicken was substituted with a breaded chicken. She said that he has eaten chicken nuggets in the past and she thought that the breaded chicken was similar to the chicken nuggets since the meal was sealed and there was no way to know if the breading was the same or different. The particular chicken is no longer served to the child. The staff also watch for any reaction as the child could have a new reaction to foods that are currently safe. She said about 20-30 minutes later C1 said that he wasn't feeling well. She noticed him scratching his head multiple times. She checked him for any breathing difficulty but his breathing was fine. She called his mother that he had a reaction to the food he ate and she administered Benadryl and water. Mother picked up child. Child did not need medical treatment and returned the next day that that he was to attend. If the child were to have difficulty breathing, the staff would call 911 and determine if an epinephrin auto-injector mediation would be necessary.

It appears that the staff followed the food service plan for C1. The replacement breaded chicken may have been the cause of the food allergy. He has not been served this type of chicken again. Staff followed appropriate allergic reaction medication administration based on post meal wellness check of C1.

No citation issued based on the incident.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1