Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493000608
Report Date: 03/27/2018
Date Signed: 03/27/2018 04:37:30 PM

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:HEAD START - PETALUMAFACILITY NUMBER:
493000608
ADMINISTRATOR:STARK, MYRNAFACILITY TYPE:
850
ADDRESS:110 ELLIS STREETTELEPHONE:
(707) 778-3896
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:20CENSUS: 11DATE:
03/27/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:MaryCarmen Olivares, Head TeacherTIME COMPLETED:
04:45 PM
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An inspection was made to the facility by LPA, N.Cunningham. LPA attempted to conduct inspection on 3/16/18 at 12:30pm. 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. Personnel are fingerprinted and associated to the Head Start- Lincoln Center site # 490111008. This program is operated by Head Start and a Title 5 funded program.

Operating hours are 8-12 and 12:15-4:15, Mon-Thurs. The facility currently follows the Petaluma school district calendar. The facility was toured inside and outside and the floor and yard plan were verified. The items which could pose a danger to children (detergents, cleaning compounds and medications) were inaccessible to children. The head teacher states no Poisons are stored at the facility and none were observed. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces appeared clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children’s bathrooms appeared in safe and sanitary condition. A current menu was posted. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There is wood chips underneath climbing structures and/or play equipment sufficient to absorb falls. There were no bodies of water observed. The head teacher stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and children were being properly supervised.

see 809c
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: 707-588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2018
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: HEAD START - PETALUMA
FACILITY NUMBER: 493000608
VISIT DATE: 03/27/2018
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The facility was operating within the licensed capacity. At least one staff member present possessed current CPR and First Aid certifications. The sign in/out procedure was reviewed and in compliance. This facility is providing Incidental Medical Services – 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, were reviewed and discussed with the head teacher. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: 707-588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2018
LIC809 (FAS) - (06/04)
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