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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317580
Report Date: 01/24/2020
Date Signed: 01/24/2020 10:16:15 AM

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:ELMWOOD ELEMENTARY SCHOOLFACILITY NUMBER:
390317580
ADMINISTRATOR:SEMILLO, JOHNFACILITY TYPE:
850
ADDRESS:840 S. CARDINALTELEPHONE:
(209) 933-7180
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY:24CENSUS: 17DATE:
01/24/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Angelica MontesTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Stacey Williams conducted a plan of correction inspection on today's date. LPA met with Associate Teacher, Angelica Montes. LPA observed (17) seventeen preschool children supervised by three staff.

On January 08, 2020, LPA conducted an annual inspection at the preschool. During the inspection, LPA observed buildings and grounds deficiencies. LPA received notification of work orders for the recommended repairs . LPA toured the outdoor activity area during today's inspection. Deficiencies will be cleared on today's date.

LPA made observations at various work centers during today's inspection that included adequate ratio and supervision.

Plan of correction clearance letter and appeal rights was provided to the Associate Teacher. Exit interview conducted and notice of site visit was posted.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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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