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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010253
Report Date: 08/16/2022
Date Signed: 08/16/2022 05:08:09 PM

Document Has Been Signed on 08/16/2022 05:08 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:EARLY HEAD START 2 - LEWIS PS/TODFACILITY NUMBER:
493010253
ADMINISTRATOR:LISA GROCOTTFACILITY TYPE:
850
ADDRESS:2230 LOMITAS AVENUETELEPHONE:
(707) 544-6911
CITY:SAN JOSESTATE: CAZIP CODE:
95404
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: DATE:
08/16/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lisa GrocottTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Lisa Grocott to conduct a prelicensing inspection of the facility. This is a combination center. The applicant submitted a preschool with toddler option application and an infant application. The application was received on July 26, 2022. The fire clearance has not been approved by the Santa Rosa Fire Department.

There are two classrooms. A preschool and toddler room. There is sufficient square footage in each room to support the program which will operate within. The preschool room has sufficient age appropriate furniture, equipment and toys for the children in care. There are two toilets and two sinks in the preschool room and cots for the children to use for nap time.

The toddler room also has sufficient square footage and age appropriate equipment, furniture and toys for the children. There are two toilets and two sinks in the toddler classroom. 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 extinguishers rated at 4A80BC in each room. There are first aid kits in each classroom. 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. The licensee will submit a request for a waiver to share the outdoor activity area between the preschool age group and the toddler age group children on a rotational schedule. There is sufficient shade in 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: EARLY HEAD START 2 - LEWIS PS/TOD
FACILITY NUMBER: 493010253
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 facility will be approved for licensure contingent upon an approved fire clearance and the outdoor area which has a department approved physical barrier to separate the outdoor play structure from use by the toddlers who may not meet the age requirement of the play structure.

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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