PORTOLA HEAD START

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 8/31/22 at 12 pm, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. This program is operated by Head Start and a Title 5 funded program and the hours of operation are 7:45 am - 1:45 pm, Monday–Friday. The facility was toured at 12 pm inside and outside and the floor and yard plan submitted by the licensee were verified. The facility representative and 2 staff were supervising 12 children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises. The outdoor activity space was cushioned with grass and wood chips and free of hazards. Facility representative was reminded that all adults 18 and over, 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. Ten children's records were reviewed at 12:22 pm. Three staff records were reviewed at 12:07 pm SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Carrie Wisehart LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 2 FACILITY NAME: PORTOLA HEAD STARTFACILITY NUMBER: 325405550 VISIT DATE: 08/31/2022 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm There were no deficiencies cited during today’s inspection A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Site Supervisor and Site Manager, Sherry Hornback and Gina Woods. To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Carrie Wisehart LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25On 8/31/22 at 12 pm, an annual inspection was made to the facility by Licensing Program Analyst (LPA), Wisehart. This program is operated by Head Start and a Title 5 funded program and the hours of operation are 7:45 am - 1:45 pm, Monday–Friday. The facility was toured at 12 pm inside and outside and the floor and yard plan submitted by the licensee were verified. The facility representative and 2 staff were supervising 12 children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises. The outdoor activity space was cushioned with grass and wood chips and free of hazards. Facility representative was reminded that all adults 18 and over, 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. Ten children's records were reviewed at 12:22 pm. Three staff records were reviewed at 12:07 pm SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Carrie Wisehart LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04)Page: 1 of 2 FACILITY NAME: PORTOLA HEAD STARTFACILITY NUMBER: 325405550 VISIT DATE: 08/31/2022 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm There were no deficiencies cited during today’s inspection A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Site Supervisor and Site Manager, Sherry Hornback and Gina Woods. To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process. SUPERVISORS NAME: Megan Aviles LICENSING EVALUATOR NAME: Carrie Wisehart LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022

Type B citation - potential risk if not corrected