185400809-9-21-2022-13-CC-CWIT-CJGUHV-20220921153631

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 185400809
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:36:38 PM

Document Has Been Signed on 09/21/2022 03:36 PM - It Cannot Be Edited

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:	LEAVITT LAKE HEAD START		FACILITY NUMBER:	185400809
ADMINISTRATOR:	MONCADA, SHARLEE		FACILITY TYPE:	850
ADDRESS:	710-400 WILLOW		TELEPHONE:	(530) 257-7530
CITY:	SUSANVILLE	STATE: CA	ZIP CODE:	96130
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 20	CENSUS: 6	DATE:	09/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Sharlee Moncada, Site Supervisor		TIME COMPLETED:	02:30 PM

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On 9/21/22 at 1:05 pm, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. This program is operated by Sierra Cascade Family Opportunities Head Start and is a Title 5 funded program. The operating hours are 7:45 am - 2:45 pm, Monday/Tuesday and Thursday/Friday. Wednesdays they operate from 7:45 am - 12:15 pm. The facility was toured at 1:10 pm inside and outside and the floor and yard plan submitted by the licensee were verified. There were 6 children and 3 staff present for the 1/2 day session, and operated within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises The outdoor activity space was cushioned with wood chips and free of hazards.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Six children's records were reviewed at 1:55 pm. Three staff records were reviewed at 1:23 pm.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: LEAVITT LAKE HEAD START	FACILITY NUMBER: 185400809
	VISIT DATE: 09/21/2022

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

There were no deficiencies cited during today’s inspection

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Sharelee Moncada.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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