Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125401106
Report Date: 03/27/2018
Date Signed 03/27/2018 12:01:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
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: 27DATE:
03/27/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tracy NordTIME COMPLETED:
12:00 PM
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An annual/random inspection was made to the facility by LPA Brian Junger. 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. Operating hours are for classrooms #1 and #2 are 8:00am to 5:00pm, Mon-Fri, and 8:00am to 3:00pm, Mon-Thurs. The facility was toured inside and outside and the floor and yard plan were verified; classroom #3 is currently not used by children. The items which could pose a danger to children (sharps, cleaning compounds and medications) were inaccessible to children. The toys, floors, desks and other equipment and surfaces appeared clean, safe, and in good condition. There was uncontaminated drinking water available to children both indoors and outdoors. The children's bathrooms appeared in safe and sanitary condition. Food is provided at the center and a current menu was posted. Food preparation areas were clean and food was properly stored, protected from contamination, and refrigerated as needed. Garbage cans containing solid waste had tight-fitting lids. There was a working carbon monoxide detector in the facility. The playground and playground equipment appeared in safe condition and free of hazards. There was rubber mat cushioning underneath climbing structures and/or play equipment sufficient to absorb falls. There were no bodies of water observed. The licensee stated no weapons or poisons are stored on site and none were observed. During today's inspection, staffing ratios were being met and children were being properly supervised; all children were on a field trip during part of the inspection. The facility was operating within the licensed capacity. The sign in/out procedure was reviewed and in compliance. Children’s records were reviewed and contained signed admission agreements. Staff records were reviewed and contained documentation of education and training, as required. At least one staff member present possessed current CPR and First Aid certifications which expire 4/2019. This facility is providing Incidental Medical Services – IMS. An IMS Plan of Operation is on file. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 licensee. 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: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Brian JungerTELEPHONE: (530) 895-5021
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
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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