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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010253
Report Date: 04/30/2024
Date Signed: 04/30/2024 02:49:09 PM

Document Has Been Signed on 04/30/2024 02:49 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:EARLY HEAD START 2 - LEWIS PS/TODFACILITY NUMBER:
493010253
ADMINISTRATOR/
DIRECTOR:
CYNTHIA KINGFACILITY TYPE:
850
ADDRESS:2230 LOMITAS AVENUETELEPHONE:
(707) 544-6911
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 28TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
04/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Marycarmen OlivaresTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Amy Strother made an unannounced Case Management visit to the facility and met with facility representative, Center Director, Marycarmen Olivares (D1). On 03/26/24 the Department received an Unusual Incident Report, reporting that on 03/25/24 around 11:30am, following a transition with the children in room #17 from outside to inside, D1 conducted a head count and realized that one child (C1) was left outside on the fully fenced play yard. It was reported that D1 immediately went outside and C1 was found on the play yard and brought back inside. The report states that C1 was left unattended for about 3 minutes and that Head Start Area Supervisor as well as C1’s parent were notified immediately. The facility reported that immediate action was taken, to include a staff training on the same day that the incident occurred. The staff training included how to use the transition forms, how to transition from outside to inside and inside to outside, and a review of the Active Supervision Policy. On 04/22/24 LPA received copies of Head Start/Early Head Start Transition Safety and Supervision Child Tracking Sheet, Transitions and Transition Safety & Supervision Child Checklist, and the Active Supervision Policy from the ECE Assistant Director of Head Start/Early Head Start in an email.

This facility is a preschool with a toddler component. The preschool children are located in room #17 and toddlers in room #18. During today’s visit, the children in rooms #17 and #18 were sleeping when LPA arrived. Room #17 had 9 children, supervised by 3 staff and room #18 had 6 children, supervised by 2 staff. D1 informed LPA that no transitions from the classroom would occur for the remainder of the day, stating that children are picked up after nap time. LPA asked D1 for a detailed explanation on how transitions from inside to outside and outside to inside are conducted. D1 stated that the children line up at the door, are counted and then marked off on the Transitions and Transition Safety & Supervision Child Checklist located in a binder, as they exit or enter the classroom and the total number recorded at the bottom of the list. D1 stated that the group of children only have one transition as a group from inside to outside and one transition from outside, back indoors. D1 explained that she uses the additional in/out columns to track when a student leaves the group for services or to use the bathroom with a staff person, accounting for the children at all times.

Continue on LIC809-C

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: EARLY HEAD START 2 - LEWIS PS/TOD
FACILITY NUMBER: 493010253
VISIT DATE: 04/30/2024
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D1 stated that one teacher will be ready to receive the children inside or outside, one teacher will stand at the door putting a mark next to the child's name as they enter or exit and a third teacher will check that no child is left inside or outside and then close the door. LPA reviewed the completed Transitions and Transition Safety & Supervision Child Checklists in the binder, providing technical assistance to D1 regarding consistency on recording the in/out section and total count when children return to the classroom. D1 stated that they use a white board to record the total number of children inside, but do not have a white board outside, but use the binder for counts. D1 stated that the binder is located on the water bottle cart while outdoors. D1 demonstrated a clear understanding of how to conduct transitions with children, stating that she feels confident with the way that transitions are being conducted and is happy to have the system in place.

There were no Title 22 deficiencies cited during today's inspection.

This report was reviewed and discussed with Facility Representative, Marycarmen Olivares. Appeal Rights were provided.

Notice of Site Visit shall be posted for 30 days from today's visit. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
LIC809 (FAS) - (06/04)
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