566210014-6-14-2022-17-CC-BCES-CFDU3F-20220614151328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566210014
Report Date: 06/14/2022
Date Signed: 06/14/2022 03:13:37 PM

Document Has Been Signed on 06/14/2022 03:13 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	CDR - JEFF DAVIS HEAD START		FACILITY NUMBER:	566210014
ADMINISTRATOR:	SUZANNE GODINEZ		FACILITY TYPE:	850
ADDRESS:	601 WEST HILL STREET		TELEPHONE:	(805) 487-6797
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	48	CENSUS: 17	DATE:	06/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Deedra Busch		TIME COMPLETED:	03:30 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	On June 14, 2022 at 1:05PM, Licensing Program Analyst (LPAs) Betzayra Cervantes and Susana Martinez made an unannounced visit to conduct a Required - 1 Year inspection. LPA met with Site Supervisor Deedra Busch and discussed the nature and purpose of the visit and a tour of the facility was conducted both inside and outside. LPA conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA observed a total of 17 children under the care and supervision of 6 staff members including the Site Supervisor. The center currently operates from August to June from 8:00AM - 2:00PM, Monday through Friday. The center utilizes two (2) classrooms, "G" and "F" which were observed free of hazards and are equipped with age appropriate toys, teaching materials, and furnishings for children in care. The bathrooms were observed to be clean and sanitary. Waste containers have tight-fitting covers. There is drinking water readily available for children inside and outside the classrooms. The facility provides breakfast, lunch and snack for children in care. Menus were posted along with the site's facility license and Emergency Disaster Plan. The playground is fenced with appropriate shading and was observed in good condition and free of hazards. The areas around or under high climbing equipment have cushioned material. No bodies of water were observed on the premises. Sign in/out sheets were reviewed and found complete. Staff records were reviewed and found complete. A sampling of children records were reviewed and LPA observed Admissions Agreement and Identification and Emergency Notification forms on file. CPR and First Aid cards are current with an expiration date of 03/09/2023. AB 1207 Mandated Reporter training certificate is current with an expiration date of 08/12/2023. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CDR - JEFF DAVIS HEAD START	FACILITY NUMBER: 566210014
	VISIT DATE: 06/14/2022

NARRATIVE

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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

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/inspection-process.

Site Supervisor 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 Site Supervisor 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 Site Supervisor 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.

No deficiencies were cited during today's visit. Exit interview conducted and report was reviewed with Site Supervisor, Deedra Busch.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra Cervantes	TELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022

LIC809 (FAS) - (06/04)

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