343622733-12-20-2019-53-CC-ASIS-BK2TPL-20191220135430

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622733
Report Date: 12/20/2019
Date Signed: 12/20/2019 01:54:41 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:	NICHOLS PRESCHOOL		FACILITY NUMBER:	343622733
ADMINISTRATOR:	LOPEZ, MARY LISA		FACILITY TYPE:	850
ADDRESS:	1301 SOUTH CRESCENT AVENUE		TELEPHONE:	(209) 331-7378
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY:	24	CENSUS: 23	DATE:	12/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Toribia Gallegos		TIME COMPLETED:	02:30 PM

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	Licensing Program Analyst (LPAs) Alecia Sifuentes and Jeevun Birk-Miller met with Toribia Gallegos, Site Supervisor, for an unannounced annual/random inspection. Twenty-three preschool-age children and three staff members were present. The program conducts part-time sessions in Portable 26 on the campus of the elementary school, 8:00 - 11:00 a.m. and 12:00 - 3:00 p.m. A tour of facility was conducted inside and outside. Portable 26 has a bathroom with two toilets and two sinks, and a second sink is available to children in the classroom. A waiver for shared playground is on file and posted. There was sufficient staff to meet ratio requirements. Drinking water is available both inside and outside. Cleaning solutions and other items that are dangerous to children are kept in a safe place inaccessible to children. Four children’s files were reviewed. Consent for Medical Treatment and Identification cards are located in a binder separate from the children's files. All children's immunization records are located in the main office. Adequate supervision was provided during today’s visit. The program provides morning snack, lunch, and menu is posted. Sign in/sign out sheets and roster are maintained. Two staff file was reviewed showing current CPR/First Aid Certificate expiring on 10/17/2021. All staff have criminal record clearance through the Lodi Unified School District, health screening report and immunizations, and documentation of the educational background and experience. LPA confirmed annual fees are current. Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

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: NICHOLS PRESCHOOL	FACILITY NUMBER: 343622733
	VISIT DATE: 12/20/2019

NARRATIVE

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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 Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Site Supervisor and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the Site Supervisor understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

LIC809 (FAS) - (06/04)

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