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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001097
Report Date: 08/16/2024
Date Signed: 08/16/2024 10:45:42 AM

Document Has Been Signed on 08/16/2024 10:45 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HEAD START - KIDDERFACILITY NUMBER:
483001097
ADMINISTRATOR/
DIRECTOR:		CHAND, VERONICAFACILITY TYPE:
850
ADDRESS:1657 KIDDER AVENUETELEPHONE:
(707) 304-2015
CITY:FAIRIFELDSTATE: CAZIP CODE:
94533
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
08/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Stefany MarmolTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Glenn Ouye arrived to conduct a case management visit regarding a reported incident where a staff (S1) spoke inappropriately with children present and also handled children in a rough manner.

No children were present today, as the site is closed on Friday. The Home Base Supervisor and her staff were present and called Site Supervisor, Veronica Chand so LPA Ouye could speak with her regarding staff S1. LPA Ouye interviewed the Site Supervisor over the phone 9:30am. Site Supervisor said that two staff reported to her about S1's inappropriate language and how she was handling the children.

LPA will return to interview staff who reported witnessing the incidents.

No deficiencies cited at this time.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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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