Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008113
Report Date: 08/29/2017
Date Signed 08/29/2017 02:09:03 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:DEANNA PANAGESFACILITY TYPE:
850
ADDRESS:10288 STARR ROADTELEPHONE:
(707) 837-0917
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:40CENSUS: 34DATE:
08/29/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Josefina FiguroaTIME COMPLETED:
02:30 PM
NARRATIVE
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LPAs Kevin O'Connell and Yang Yang made an unannounced inspection regarding compliance with Title 22 Regulations. The facility file was reviewed prior to the inspection. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Hours are Monday-Thursday from 8:00AM- 2:15PM on the "Martinez side" and Monday- Thursday 9:00am-3:15 on the "Guillory side." This center is licensed for 40 children. Present were 34 children and 6 staff. Fire extinguishers were charged and at least one carbon monoxide detector was functioning. There is also a pull- down alarm. Smoke detectors are hard wired and there are sprinklers throughout the building.
During today's inspection staffing ratios were being met.
The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Disinfectants and cleaning solutions are stored in a closet behind the kitchen. The toys, floors, desks, and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's bathrooms appeared in safe and sanitary operating condition.
The playground was completely fenced and the equipment appeared in safe condition. There was bark under the climbing structures/ play equipment to absorb falls. Trash cans used for solid waste did have tight fitting lids. Breakfast and lunch is served. Menus were posted.
Furnishings, equipment, toys and activities are age and developmentally appropriate, found in safe condition.
Children's files were reviewed for Parent's Rights Notification & the blue PM 286 Immunization form.

Incidental Medical Services (IMS) policy was discussed. This facility is providing IMS-(inhaler as needed). This facility provides Incidental Medical Services – IMS. 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.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2017
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: HEAD START - MARTINEZ & GUILLORY CENTER
FACILITY NUMBER: 493008113
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2017
Section Cited
CCR
1596.7995
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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Josefina states that she will provide proof of correction to LPA by 9/8/17.

kevin.oconnell@dss.ca.gov
yang.yang@dss.ca.gov
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Today there were at least 3 teachers that did not have evidence of Influenza or a signed opt out form.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2017
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 CENTER
FACILITY NUMBER: 493008113
VISIT DATE: 08/29/2017
NARRATIVE
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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: http://www.ada.gov/childqanda.htm

All licensing reports are public information and must be made available upon request for at least three years.
Director states that there are no pools, spas, hot tubs, fish ponds or bodies of water and none were observed.
Director states that there are no guns or dangerous weapons and none were observed.

Child Abuse Mandated Reporter Training information (free) was given during visit.
Personnel Immunization records for Measles, Pertussis, Influenza were reviewed.

Child Care Providers Guide to Safe Sleep was given
English: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https://www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf


Notice of Site Visit shall be posted for 30 days from today's visit.
The following violations of the California Code of Regulations, Title 22; Division 12, were observed:
see LIC 809D. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Failure to keep this notice posted for 30 days may result in a civil penalty.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2017
LIC809 (FAS) - (06/04)
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