Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503600291
Report Date: 04/08/2016
Date Signed: 04/08/2016 10:55:04 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:EMPIRE HEAD STARTFACILITY NUMBER:
503600291
ADMINISTRATOR:CENTENO, CONSUELOFACILITY TYPE:
850
ADDRESS:5201 FIRST STTELEPHONE:
(209) 527-9884
CITY:EMPIRESTATE: CAZIP CODE:
95319
CAPACITY:20CENSUS: 0DATE:
04/08/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Rosemary SandovalTIME COMPLETED:
11:30 AM
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An unannounced annual/random visit #2 is made today by LPA Claudia Henley. Met with Rosemary Sandoval, Program Coordinator. A tour of facility was conducted inside and outside. There were no children at the center today. Staff were spoken to during visit. The following areas are in compliance during this visit: There are no bodies of water, except for a small fish tank with a cover. Disinfectants, hazardous items and medications are inaccessible to children. Storage area for poisons is locked. Furniture and equipment are sufficient, age appropriate and in good repair. The playground equipment and outdoor activity space is maintained and in good condition with adequate rubber cushioning material. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Food preparation area is clean, food and beverages are stored in covered containers at 45 degrees or less if required, and storage containers for solid waste are covered. Drinking water is available both indoors and outside. Measures are taken to keep facility free of insects and rodents. Staff subject to a criminal record clearance or exemption are associated to the facility. No excluded individuals are present. First Aid/CPR reviewed and in compliance. Sign in/sign out sheets are maintained. Emergency information forms reviewed for some children. There were inhalers on the premises. Licensee has an accepted Incidental Medical Services Plan of Operation on file with the department. Staff records contain documentation of education, training, and/or experience. Menus are posted. The child care center operates two sessions, Monday through Thursday, 8:00 a.m. to 11:30 a.m. and 12:00 p.m. to 3:30 p.m.

No deficiencies observed in the areas inspected during today's visit.

Site Visit Notice posted on the parent board. Exit interview was conducted.
SUPERVISOR'S NAME: Valarie ReedTELEPHONE: (559) 243-8093
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 243-4588
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2016
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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