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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317918
Report Date: 11/27/2023
Date Signed: 11/27/2023 11:28:57 AM


Document Has Been Signed on 11/27/2023 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CLAIRMONT STATE PRESCHOOLFACILITY NUMBER:
390317918
ADMINISTRATOR:LOPEZ, MARY LISAFACILITY TYPE:
850
ADDRESS:8282 LE MANS AVENUETELEPHONE:
(209) 953-8284
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:48CENSUS: 16DATE:
11/27/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Teacher, Viengthong KeosavangTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Elizabeth Santiago met with teacher, Viengthong Keosavang for the purpose of an unannounced annual inspection. There were 16 children present during today's inspection in room 33 and 35. Facility days and hours of operation are Monday-Friday from 7:00 AM to 11:30 AM, closed during summer. LPA reviewed the sign in/out book and observed that the children are properly signed in.

Teacher was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA reviewed care and supervision of children, staffing ratios, medications and first aid supplies, furniture, equipment, fire drills and drinking water. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, there is sufficient cushioning under the play structure to prevent the fall. LPA observed all required forms to be posted. Facility provides lunch to children in care. All food is prepared off site by the school district and brought into the facility.

Report continues on 809-C

SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Elizabeth SantiagoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/27/2023
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CLAIRMONT STATE PRESCHOOL
FACILITY NUMBER: 390317918
VISIT DATE: 11/27/2023
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LPA reviewed children’s and staff files. LPA observed health screening reports with TB test and required MMR and TDAP vaccines for all staff members. At least one staff member present today has current Pediatric CPR and First Aid. LPA observed AB1207 mandated reporter training for all staff. The facility was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

LPA referred teacher to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.



Teacher was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the teacher, Viengthong Keosavang. A notice of site visit was given and must remain posted for 30 days.

In the areas that were evaluated, no deficiencies were cited during the inspection.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: Elizabeth SantiagoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2