493010442-8-4-2023-01-CC-GOUE-CUDNDX-20230804102303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493010442
Report Date: 08/04/2023
Date Signed: 08/04/2023 10:23:10 AM

Document Has Been Signed on 08/04/2023 10:23 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 - CARITAS VILLAGE		FACILITY NUMBER:	493010442
ADMINISTRATOR:	GROCOTT, LISA		FACILITY TYPE:	850
ADDRESS:	465 A STREET		TELEPHONE:	(707) 544-6911
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95401
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 28	CENSUS: 0	DATE:	08/04/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lisa Grocott		TIME COMPLETED:	10:30 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 Lisa Grocott to conduct the prelicensing inspection for this new cite. The application was received on May 24 2023. The approved fire clearance was approved on June 6, 2023 for a capacity of 28 children. The capacity on the application is seeking a license for 18 children. The address will be corrected to 301 6th Street, Suite 123, Santa Rosa, Ca 95401. This is a new building. The construction of the building was completed in 2022. The facility will not be required to conduct lead water testing. Applicant 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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) or (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. 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: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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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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 - CARITAS VILLAGE	FACILITY NUMBER: 493010442
	VISIT DATE: 08/04/2023

NARRATIVE

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The program has a open single classroom. There is a bathroom with two toilets and two sinks. There is an office for the staff for the director and staff. The is sufficient furniture, equipment and toys for the children. There is also sufficient cots for children to use for napping. There is a kitchen for food and snack prep. There is sufficient indoor square footage to support 18 children. There is functioning smoke, carbon monoxide detectors and a fire extinguisher rated at 3A40BC.

The outdoor activity area is fully fenced. The outdoor surface has rubber mats over concrete. There is sufficient shade. The program will mostly use ground based activity equipment. Individual refillable water bottles will be used by the children for hydration. The outdoor activity square footage supports 18 children.
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 platforms. 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.

Any notice of site visit must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

The license for this site is approved effective August 4, 2023

Exit interview conducted and report was reviewed with Program Director Lisa Grocott.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC809 (FAS) - (06/04)

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