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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010252
Report Date: 08/16/2022
Date Signed: 08/16/2022 02:19:33 PM

Document Has Been Signed on 08/16/2022 02:19 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 - GUILLORYFACILITY NUMBER:
493010252
ADMINISTRATOR:TBDFACILITY TYPE:
830
ADDRESS:10288 STARR ROADTELEPHONE:
(707) 544-6911
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
08/16/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lisa GrocottTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Lisa Grocott to license this site. This facility was formerly part of the Head Start Martinez-Guillory facility. There are two licenses at this location. The Head Start Martinez-Guillory facility which is a preschool license and (this facility) Head Start - Guillory which is an infant with toddler component license. The application was received on July 26, 2022. The fire clearance was approved by the Sonoma County Fire District on August 3, 2022.

There are two rooms. A toddler room and an infant room. There is sufficient square footage in each room to support the program which will operate within. The infant room has a nap area with sufficient cribs and cots for the infants in the infant program. There is a changing table within arms reach of a sink. There is another sink for the children in care. There is sufficient age appropriate equipment, furniture and toys for the infants in care.

The toddler room also has sufficient age appropriate equipment, furniture and toys for the children. There are two toilets and one sink in the toddler area. There are sufficient cots for the children to use during nap time.

There is a functioning smoke detector, carbon monoxide detector as well as a charged fire extinguisher. The first aid kit is next to the entry door of the infant room. The director is aware of the requirement to conduct emergency disaster drills every six months, however the facility does the disaster drills monthly. The facility uses an electronic sign in and sign out program called Child Plus to document all children's arrival and departure to the facility.
The outdoor area has sufficient square footage to support the approved capacity, however the licensee will utilized a waiver to share the outdoor activity area between the infant age group and the toddler age group children on a rotational schedule. There is sufficient shade covering a majority of the outdoor area.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2022
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: HEAD START - GUILLORY
FACILITY NUMBER: 493010252
VISIT DATE: 08/16/2022
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Program Director was reminded that all adults 18 years and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed the safe sleep regulations with [applicant, licensee, or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.

The infant and toddler license is approved for licensure effective today, August 16, 2022 for eight infants and eight toddlers.

Exit interview conducted and report was reviewed with the applicant, Lisa Grocott.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC809 (FAS) - (06/04)
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