Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008113
Report Date: 11/07/2019
Date Signed: 11/18/2019 05:51:15 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 - MARTINEZ & GUILLORY CENTERFACILITY NUMBER:
493008113
ADMINISTRATOR:LISA GROCOTTFACILITY TYPE:
850
ADDRESS:10288 STARR ROADTELEPHONE:
(707) 837-0917
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:40CENSUS: 28DATE:
11/07/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Teresa Diaz & Josefina FigeroaTIME COMPLETED:
09:55 AM
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A case management visit was made to the facility by Licensing Program Analyst (LPA), Leticia Rosales-Meza to conduct a well check on the facility and inquire about any unmet needs at the facility due to the 2019 Kincade fire. During today's case management visit, LPA met with the Center Directors, Teresa Diaz and Josefina Figeroa. The Center Directors stated that they currently do not have any unmet needs and is operational as of today, 11/07/19 after being closed for eight days due to the 2019 Kincade fire. Teresa Diaz, Center Director stated that they follow the School District and they opened today as well. LPA observed a total of 28 children being supervised by 8 staff members at the facility in both classrooms. The Center Directors stated that the facility did not sustain any structural damages due to the wildfire. This report was read and reviewed with the licensee.
Report with original signatures in facility file.


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) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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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