Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803229
Report Date: 02/15/2018
Date Signed 02/15/2018 10:29:52 AM

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: 29DATE:
02/15/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Mallory Centeno DominguezTIME COMPLETED:
10:29 AM
NARRATIVE
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A random annual inspection is being conducted as part of a compliance review. Licensing Program Analyst (LPA), Ana Noble and Reginald Smith, toured the center, inside and out. The following was observed:
· A review of the staff records and a review of a sampling of children's records were conducted as part of this evaluation. See Confidential Names List (LIC811)
· 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)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Menu
· The facility is operating within the terms of the license
· Ratios were met during this inspection
· Appropriate supervision was provided during this inspection
· Classrooms are equipped with age appropriate furniture and equipment in good condition
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2018
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: 02/15/2018
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vPlease subscribe at www.childcareadvocatesprogram@dss.ca.gov to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
vThe Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

IF a Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

An exit interview was conducted and during the interview, the Site Manager, Mallory Centeno-Dominguez confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

A NOTICE OF SITE VISIT WAS ISSUED AND IS TO BE POSTED IN A PROMINENT LOCATION AT THE FACILITY FOR THE NEXT 30 DAYS ALONG WITH A COPY OF ALL TYPE A DEFICIENCIES (LIC809D/9099D) CITED DURING THIS INSPECTION. A COPY OF ALL TYPE A DEFICIENCIES CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (within 24 hours of the child’s next day in care) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS.
Appeal rights were provide and discussed. This report must be available for review, upon request, for the next 3 years.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2018
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: 02/15/2018
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·A review of staff records on 2/15/18 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· 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.

No deficiencies cited.

The following was also reviewed and discussed:
vAB 2084 - Nutritious Beverages in Child Care Facilities effective January 1, 2012
vAB 2621 – Public Information effective January 1, 2015
vAB 2236 – Civil Penalties, effective July 1, 2015
vAB 2386 – Carbon Monoxide Detector Regulations, effective January 1, 2015
vSB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016
vAB290 – Child Nutrition, effective January 1, 2016
vSB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1596.7995(a)(1)
vAB2231 (2016) – Increased Civil Penalties, effective July 1, 2017
vNOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
vEffective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov
vAccess to forms & Regulations for a Child Care Center are online at www.ccld.ca.gov.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2018
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 02/15/2018
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·Classrooms are clean and free of hazards
· All floors shall be kept clean and safe
· No weapons stored at the facility
· 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.
· Medications are stored where inaccessible to children
· Hazards are stored where inaccessible to children which includes: disinfectants, cleaning solutions and other items that are dangerous to children
· Poisons and toxins are locked
· 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.
· Uncontaminated drinking water shall be readily available both indoors and out and are provided by drink fountains.
· 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
· Opening and closing staff member’s CPR/First Aid expires on
· Director completed Health and Safety Training
· Records were reviewed ensuring the children’s files contain the names and contact information of authorized representatives and others who can assume responsibility for the child when necessary
· Records were reviewed ensuring that the staff files contain documentation of the educational background, training and/or experience required, Staff present during todays' visit have previously been reviewed during 2017 Annual Visit.
· Documentation of fire & earthquake drills to be conducted every six months
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2018
LIC809 (FAS) - (06/04)
Page: 2 of 4