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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 053604818
Report Date: 09/19/2019
Date Signed: 09/19/2019 01:43:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:MARK TWAIN EXTENDED DAY PROGRAMFACILITY NUMBER:
053604818
ADMINISTRATOR:KRISTIAN LERETTEFACILITY TYPE:
840
ADDRESS:645 STANISLAUSTELEPHONE:
(209) 736-2790
CITY:ANGELS CAMPSTATE: CAZIP CODE:
95221
CAPACITY:45CENSUS: 6DATE:
09/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Danielle ThompsonTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Justin Denton met with Site Supervisor Danielle Thompson for the purpose of an annual random inspection. LPA toured the program site including all activity and classroom spaces, restrooms, and outdoor play areas. LPA observed appropriate ratios, care and supervision, and capacity during the visit.

Medications, disinfectants, cleaning solutions, and hazardous items were appropriately stored and inaccessible to children. Furniture, equipment, and play materials were in good condition. Playground equipment was free of loose and sharp parts. The areas under and around playground climbing equipment were cushioned with materials to absorb falls. Toileting facilities were in an operating, safe and sanitary condition. All food was covered to protect against contamination. Trash cans containing solid wastes had lids. Uncontaminated drinking water was readily available to children both indoors and outdoors. Snack menu was posted in a visible area. LPA observed Sign In/Out Sheet with signatures, times, and dates.

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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: MARK TWAIN EXTENDED DAY PROGRAM
FACILITY NUMBER: 053604818
VISIT DATE: 09/19/2019
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Children’s records were reviewed and included contact information of responsible parties and admission agreements. At least one person present today had current Pediatric CPR and First Aid certification (expires 01/27/20). All staff currently employed with the facility have criminal record clearances and documentation of qualifications including education and experience at the district office. LPA discussed the Departmental inspection authority, and also informed the Licensee that any changes regarding the Center Director or their Designee must be reported to Department within 10 working days.

An Exit Interview was conducted. A Notice of Site Visit was provided. Licensee was encouraged to the visit the Departmental website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, provider information notices, regulations and legislation pertaining child care centers.

No Title 22 Deficiencies were cited during today's visit.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Justin L DentonTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2