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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010224
Report Date: 08/19/2022
Date Signed: 08/19/2022 11:13:35 AM

Document Has Been Signed on 08/19/2022 11:13 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-KENSINGTONFACILITY NUMBER:
483010224
ADMINISTRATOR:VERONICA CHANDFACILITY TYPE:
850
ADDRESS:1875 FAIRFIELD AVENUETELEPHONE:
(707) 974-8787
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
08/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan Smith and Veronica ChandTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye arrived to conduct a prelicensing inspection for a change of location. The facility relocated from Wooler Ave, Fairfield to the location at 1875 Fairfield Ave in Fairfield, The facility will operate Monday through Friday, 8am to 4pm from August through May.

The indoor and outdoor activity areas were inspected. There is sufficient indoor space for the children in care. The classroom has sufficient furniture, equipment and toys for the children in care. There are functioning smoke detectors, a carbon monoxide detector and two fire extinguishers rated at 3A40BC. There are 3 toilets and 3 sinks for the children in care. The sign in and sign out will be done at the entry door of the classroom,

The outdoor activity area has sufficient square footage to support the maximum capacity. There is a play structure with sufficient wood chip used as fall protection. There is adequate shade for the children. The facility will use a water cooler to supply water to the children when they are using the outdoor activity area.

The staff clearance will be under the Menlo Center license.

The change of location for this site is approved effective today, August 10, 2022.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2022
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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