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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317918
Report Date: 10/15/2019
Date Signed: 10/15/2019 01:48:18 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:CLAIRMONT STATE PRESCHOOLFACILITY NUMBER:
390317918
ADMINISTRATOR:V. KEOSAVANG/S. LOR/S. CHAFACILITY TYPE:
850
ADDRESS:8282 LE MANS AVENUETELEPHONE:
(209) 953-8284
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:48CENSUS: 12DATE:
10/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Julissa VandenakkerTIME COMPLETED:
02:20 PM
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On 10/15/2019 at 11:45am Licensing Program Analysts (LPAs) Aruna Sridharan and Amanda Blesi conducted an unannounced Annual Required Inspection and met with Site Supervisor Julissa Vandenakker. This facility has two portables in the Clairemont Elementary School Campus.. 20 children and 3 staff and 2 parents were present in the facility during this inspection. Facility is within ratio during this inspection. The facility consists of two classrooms with bathroom in each classroom and an outdoor play area. The classroom has heating and ventilation for safety and comfort. This facility operates under Title 5 program. The hours of operation for AM program 7:30am to 11:00 and PM program from 12:00 to 3:30pm. The breakfast, snacks and lunch is provided by the Lodi School District in the cafeteria.

At approximately time 12:20pm the two sign in-out sheets was reviewed. LPAs conducted an indoor and outdoor tour of the facility. Site Supervisor stated that toys are sanitized by staff on a rotational basis. LPAs observed cubbies for each child labeled and orderly. All two classroom floors were clean and safe, the children's furniture was clean and toys were age appropriate. Drinking water is immediately accessible to children both indoors and outdoors. Bathrooms are working and clean.

A weekly menu was posted on the parent board with all other required postings. LPAs observed working carbon monoxide and complete first aid kit. Cleaning supplies and medication cabinets were high up and inaccessible to children. LPAs observed the outdoor play area, the play structure was securely anchored, cushioned material with woodchips underneath to absorb a fall and ample shade as well.

No Title 22 deficiencies were cited during today's inspection. LPAs read this report and an exit interview was conducted with the Site Supervisor. A copy of this report and appeal rights were discussed and left with Site Supervisor whose signature on this form confirm receipt of these documents.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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