Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503600291
Report Date: 10/01/2019
Date Signed: 10/01/2019 11:49:41 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
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: 17DATE:
10/01/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Consuelo CentenoTIME COMPLETED:
12:15 PM
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An unannounced annual/random visit #3 is made today by LPA Claudia Henley. Met with Site Supervisor Consuelo Centeno. A tour of facility was conducted inside and outside. There were 17 children present today. Staff and children were spoken to during visit. The following areas are in compliance during this visit: No bodies or water or firearms on the premises. 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. Fire/disaster drill conducted September 2019. 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. Reviewed four children's files. There were inhalers on the premises. Incidental Medical Services Plan on file with the department. Staff records were reviewed and immunization records and Mandated Reporter training certificates are on file. Menus are posted. The child care center operates Monday through Friday, 8:00 a.m to 2:30 p.m.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with Site Supervisor.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Claudia HenleyTELEPHONE: (559) 341-5776
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019
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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