Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125401106
Report Date: 05/18/2016
Date Signed 05/18/2016 12:37:49 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 - ALICE BIRNEYFACILITY NUMBER:
125401106
ADMINISTRATOR:RHODES, RAYLENEFACILITY TYPE:
850
ADDRESS:717 SOUTH AVENUETELEPHONE:
(707) 442-8977
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY:60CENSUS: DATE:
05/18/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Raylene RhodesTIME COMPLETED:
12:51 PM
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(1) LPA DeAnna Sanders visited the facility today. The facility was toured and records were reviewed. There are no fire arms or water hazards per the staff and none were observed by the LPA. Disinfectants and other toxins are inaccessible. There is locking storage for poisons. Furnishings and equipment are in good condition. Medications are stored out of reach of children. The playground is in good condition with adequate cushioning material under the climber. The floors are in adequate condition for the time of year. Regular maintenance is conducted. The kitchen is in good condition. Food is stored, prepared and served in a healthful manner. There is covered storage for garbage. There is no sign of vermin or insects. There is adequate heat light and ventilation. Interactions between the children and staff were observed to be appropriate. The rest rooms are stocked and operational. There is drinking water inside and out. No toxic surfaces are noted. The LPA was allowed to enter and inspect the facility. The facility has a central agency fingerprint list. There is a Head Start classroom and a year round classroom. The menu is posted. The children are supervised. The facility is within ratio and capacity today. Children are signed in and out with full signatures. The Director remains the same and is designated and qualified with a health screening. There is complete information on children. No deficiencies are cited today.
SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5034
LICENSING EVALUATOR NAME: Deanna SandersTELEPHONE: (707) 826-9961
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2016
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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