Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803229
Report Date: 03/13/2017
Date Signed 03/13/2017 03:10:03 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RCOE - JEFFFERSON HEADSTARTFACILITY NUMBER:
334803229
ADMINISTRATOR:YVETTE TESTAFACILITY TYPE:
850
ADDRESS:1040 S. VICENTIA AVENUETELEPHONE:
(951) 340-1526
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:37CENSUS: 31DATE:
03/13/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Mallory Centeno-Dominguez (Site Mgr)TIME COMPLETED:
03:15 PM
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Licensing Program Analysts (LPAs), Kimberly Williams and Sean Williams conducted a Comprehensive 3 year Required visit. Initially, LPAs met with Community Asst., Maribel Hernandez and Lead Teacher, Paul Gamboa. Present in classroom #1 were two staff members supervising 16 children engaged in age appropriate activities within the classroom and in classroom #2 there were two staff supervising 15 children who were engaged in circle time. Later during this visit, Site Manager, Mallory Centeno-Dominguez, arrived to meet with LPA Williams.

· A review of a sampling of the staff records and children's records were conducted as part of this evaluation. See Children’s Records Review (LIC857) and Staff Records Review (LIC859)

· The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization (only if changes have been made)
5. LIC 308 Designation of Administrative Responsibility (only if changes have been made)

· The following items have been posted and are updated where necessary:
- License
- Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kimberly WilliamsTELEPHONE: (951) 680-6841
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2017
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: RCOE - JEFFFERSON HEADSTART
FACILITY NUMBER: 334803229
VISIT DATE: 03/13/2017
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v AB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015 – In accordance with California Health and Safety Code Section 1975.543 - Every child care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections
v SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
v AB290 – Child Nutrition, effective January 1, 2016 - In accordance with California Health and Safety Code Section 1596.866 - each child care center shall have at least one person employed who was completed one hour of childhood nutrition training as part of the preventive health practices course or courses.
v SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1597.622 - a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination or they may provide a statement declining the vaccination. If employees/volunteers are receiving the influenza vaccination they must do so between August 1 and December 1 of each year.
v Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov. Please subscribe to My CCL on our website. Department updates will be sent directly to your e-mail account once you have set up an account.
v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS
Appeal rights were provide and discussed. This report must be available for review, upon request, for the next 3 years.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kimberly WilliamsTELEPHONE: (951) 680-6841
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2017
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: RCOE - JEFFFERSON HEADSTART
FACILITY NUMBER: 334803229
VISIT DATE: 03/13/2017
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· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall
· Sign in/Sign out record was reviewed and meets regulation requirements
· A Staff member is present with current Pediatric CPR/First Aid which expires on 08/14/2017
· Opening and closing staff member’s CPR/First Aid expires on 12/2017
· Director completed Health and Safety Training on 03/10/2017
· A review of children’s records was conducted and records were found to be complete during this visit
· Documentation of fire & earthquake drills to be conducted every six months
· A review of staff records on 03/13/17 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions
· A review of staff records indicates that all staff present meet minimum qualifications for the position for which they were hired
· The Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must be posted for 30 days
· Facility is providing IMS This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: http://www.ada.gov/childqanda.htm.
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kimberly WilliamsTELEPHONE: (951) 680-6841
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2017
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: RCOE - JEFFFERSON HEADSTART
FACILITY NUMBER: 334803229
VISIT DATE: 03/13/2017
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- Personal Rights (LIC613A)
- Child Car Seat Law
- Menu

· Last Disaster Drill was conducted on 02/22/2017 and a Fire Drill was completed on 02/22/2017
· The facility is operating with the limits as stated on the license
· Ratios are being met during this visit
· Classrooms are adequately equipped with age and size appropriate furniture and equipment and free of hazards
· There are no weapons present at the facility as stated by Site Manager, Mallory Centeno-Dominguez
· There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use
· Water coolers supply drinking water in the indoor activity space
· Medications are stored where inaccessible to children
· Hazards are stored where inaccessible to children which include: Disinfectants, cleaning solutions and other items that are dangerous
· Poisons and toxins are locked
· All floors shall be clean and safe
· Bathrooms were observed to be safe, sanitary and in operating condition
· Playgrounds are enclosed by appropriate fences and free of hazards
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin
· Food is stored appropriately and protected from contamination
· All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair
· Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request
· Uncontaminated drinking water shall be readily available both indoors and out and provided by water coolers and drinking fountains
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kimberly WilliamsTELEPHONE: (951) 680-6841
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2017
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: RCOE - JEFFFERSON HEADSTART
FACILITY NUMBER: 334803229
VISIT DATE: 03/13/2017
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No deficiencies cited

The following was reviewed and discussed:
v AB 2084 - Nutritious Beverages in Child Care Facilities effective January 1, 2012 - was explained that only low-fat or non-fat milk is to be served to children 2 years of age or older; and limit juice to one serving of 100% juice per day; serve no beverages with added sweeteners; and water must be available and accessible to children throughout the day
v AB 2621 – Public Information effective January 1, 2015 – The Department shall post licensing information for Child Care Facilities on it’s internet Web site to include:
· The name
· The address for each Child Care Center only
· The status of the license
· The capacity of the license for each Child Care Center only
· The number of site visits, including:
o Non-complaint inspections
o Substantiated and inconclusive complaint inspections
· The number of citations
This information is to be updated at least monthly on the website and will span the preceding five-year period.
v AB 2236 – Civil Penalties, effective July 1, 2015 – Enacts new civil penalties in cases where the Department determines that a violation of licensing standards resulted in the death or serious injury, or constitutes physical abuse of a child in care. The bill establishes an appeal procedure specific to these civil penalties. The bill also expands the scope of the Child Health and Safety Fund in order to assist parents in securing alternative child care when a Child Care Center license has been suspended or revoked. These civil penalty amounts are scaled in relation to the total capacity of all of the licensee’s facilities and not just the specific facility cited or limited to that facility type.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kimberly WilliamsTELEPHONE: (951) 680-6841
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2017
LIC809 (FAS) - (06/04)
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