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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483002942
Report Date: 10/18/2024
Date Signed: 10/18/2024 03:55:56 PM

Document Has Been Signed on 10/18/2024 03:55 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:HEAD START - LARSENFACILITY NUMBER:
483002942
ADMINISTRATOR/
DIRECTOR:		HARVEY, JOYFACILITY TYPE:
850
ADDRESS:1707 CALIFORNIA DRIVE RM 3TELEPHONE:
(707) 304-2225
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 28TOTAL ENROLLED CHILDREN: 23CENSUS: 0DATE:
10/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Maria Valdez - Center DirectorTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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An Annual/Random inspection of the facility was conducted by Licensing Program Analyst (LPA), Melchisedeck Augustin and met with the Facility Representative, Maria Valdez. 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. Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. All staff are fingerprinted and associated to the central file Head Start- Menlo Center # 280111518. The facility has an active/standing waiver which allowed special education children from an unlicensed program to mainstream in the outdoor activity area with children from the facility. The facility has a toddler component which is operated in classroom #5 and preschool is operated in classroom #3.

The facility’s operating hours are from 7:30 AM - 4:30 PM, Monday-Friday, however; the children arrived at 8:00am - 3:30pm in classroom #3 and class # 5 was 8:00am - 4:00pm. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. Parents signed their child(ren) in/out digitally/electronically. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be out of reach, inaccessible to children. LPA did not observe any poisons on the premise. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is drinking water available to children indoors and outdoors. 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. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 - LARSEN
FACILITY NUMBER: 483002942
VISIT DATE: 10/18/2024
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The menu and activity schedules were posted in classroom #3 & 5. LPA observed a working carbon monoxide detector, smoke alarm, and fire extinguisher rated at least 2A10BC in the facility. Last emergency drill was conducted on 10/07/24.


The playground equipment and surface areas are in safe condition. There is wood chips and foam padding cushioning underneath climbing structures and/or play equipment to absorb falls. There are no bodies of water observed on the site. Director stated no weapons are stored on site, and none were observed. During today's inspection, staffing ratios were being met, and no children were in care, and there were two lead teachers and three Associate teachers. The facility was operating within the licensed capacity and ratio requirements. At least one staff member (S4) present during the inspection possessed current CPR and First Aid certifications, which expire on 08/02/26. Eight staff (S1-S7 & CD) records were reviewed at 11:53 AM which revealed the records contained required staff immunization records, Health Screening (LIC 503), LIC 9108, Employee Rights (LIC 9052), and Personnel Record (LIC 501), evidence of completion of current AB 1207 Mandated Reporter Training. Five children’s (C1-C5) records were reviewed at 1:15 PM which contained all records as required. Furthermore, C4 & C5 were under 24 months old and their records contained updated Infant Needs and Services Plans, as well as evidence showing 15 minute checks was/were conducted while C4 & C5 took a nap.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HEAD START - LARSEN
FACILITY NUMBER: 483002942
VISIT DATE: 10/18/2024
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LPA requested a Plan for Providing IMS from the Facility Representative. LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.



Exit interview conducted and report was reviewed with the Facility Representative, Maria Valdez. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in a civil penalty of $100. There were no violation(s) of the California Code of Regulations, Title 22; Division 12, observed during today’s visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024
LIC809 (FAS) - (06/04)
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