493009803-8-30-2021-01-CC-ASTR-C6DRHL-20210830130232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493009803
Report Date: 08/30/2021
Date Signed: 08/30/2021 01:02:38 PM

Document Has Been Signed on 08/30/2021 01:02 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME:	EARLY HEAD START-COOK		FACILITY NUMBER:	493009803
ADMINISTRATOR:	LISA GROCOTT		FACILITY TYPE:	830
ADDRESS:	2480 SEBASTOPOL ROAD		TELEPHONE:	(707) 535-3315
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95407
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 2	DATE:	08/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Angelica Contreras		TIME COMPLETED:	01:15 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 unannounced Annual inspection was made to the facility by Licensing Program Analyst (LPA), Amy Strother. The facility file was reviewed prior to this inspection. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA met with Primary Care Giver (PCG), Angelica Contreras. Operating hours are Monday-Friday 7:30am-4:00pm. The facility was toured inside and outside and the floor and yard plan were verified. The indoor and outdoor activity space for infants is physically separate from space used by the preschool component as required. Items which could pose a danger to children (detergents, cleaning compounds and medications) were inaccessible to children. Contreras stated that poisons are not stored on site and none were observed. The facility was free of flies, insects and rodents. The toys, floors, and other equipment and surfaces appeared clean, toxic free, safe for infants and in good condition. The infant changing tables have at least 3" sides and sanitary vinyl pads that are at least 1" thick. The bathroom and hand washing area appeared to be in safe and sanitary operating condition. Facility had age appropriate furniture and equipment. There was sufficient infant napping equipment available that meet the requirements. Safe Sleep requirements were reviewed and observed to be in compliance. During the inspection, LPA Strother observed that food containers and infant bottles were labelled with children's names and/or dates. Food prep areas are clean. Food is properly stored and refrigerated as needed. Menus were posted on the refrigerator and meet the requirement of meals listed at least one week in advance. Garbage cans containing solid waste have tight fitting lids. There is uncontaminated drinking water available to children both indoors and outdoors. The playground has a padded cushioning material to absorb the children's falls. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There were no bodies of water observed. Contreras stated no weapons are stored on site and none were observed. Continue on LIC809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: EARLY HEAD START-COOK	FACILITY NUMBER: 493009803
	VISIT DATE: 08/30/2021

NARRATIVE

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Facility had a working carbon monoxide detector located in the main classroom on the wall. During today's inspection, infant staffing ratios were being met and two children were being directly supervised by 1 and then 2 staff. The facility was operating within the licensed capacity. At least one staff member present possessed current CPR and First Aid certifications. Posting requirements are met.

Sign-in/Sign-out records were reviewed and complete with signature of child's authorized representative and time of day recorded. The facility uses a digital application, Child Plus for sign-in/sign-out purposes. Contreras pulled up the digital program on the tablet during the inspection and both children were signed in as required. At 11:45am, 2 children’s records were reviewed and contained identification forms with authorized representative information, medical assessment, Infant Needs and Services Plans, individual feeding plans and Individual Infant Sleeping Plan as required. Staff records were reviewed and contained health screening forms, current mandated reporter training, proof of required immunization's and infant teacher qualifications.

This facility is not currently providing Incidental Medical Services – IMS, Contreras stated there are no children currently enrolled that require IMS. 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. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices brochure, The Effects of Lead Exposure brochure were reviewed with Contreras. All licensing reports are public information and must be made available upon request for at least three years.

There were no Title 22 deficiencies cited during today's inspection.

Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

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