Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008113
Report Date: 10/04/2018
Date Signed 10/05/2018 08:56:28 AM

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: 28DATE:
10/04/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Josefina Figuroa and Teresa DiazTIME COMPLETED:
02:25 PM
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An annual/random inspection was made to the facility by Licensing Program Analysts (LPAs), Y. Yang and J. Velasco. The facility file was reviewed prior to this visit. 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. This program is operated by Head Start.

The facility’s operating hours are 9:00am-3:15pm, Monday-Thursday in the Guillory classroom and 8:00am-2:15pm Monday-Thursday in the Martinez classroom. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. The director stated there are no poisons stored on the premises. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors on the playground. The children's bathrooms are in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. LPAs observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met, and 28 children were being supervised by six teachers/aides. The facility was operating within the licensed capacity. At least one staff member present during the visit possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Ten children’s records were reviewed at 1:15pm, and contained signed admission agreements. Seven staff records were reviewed at 1:25pm and contained documentation of education and training as required.

(Continued on 809-C)
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2018
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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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: 10/04/2018
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This facility is providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Director. LPAs 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 center's directors. 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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2018
LIC809 (FAS) - (06/04)
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