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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390319952
Report Date: 01/18/2024
Date Signed: 01/18/2024 02:39:15 PM


Document Has Been Signed on 01/18/2024 02:39 PM - 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:TAFT SCHOOLFACILITY NUMBER:
390319952
ADMINISTRATOR:SYLVIA ULMERFACILITY TYPE:
850
ADDRESS:419 DOWNING AVENUETELEPHONE:
(209) 933-7285
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:102CENSUS: 15DATE:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:42 PM
MET WITH:Lead Teacher Shawn NorthcarftTIME COMPLETED:
03:00 PM
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On 1/18/24, Licensing Program Analyst (LPA) Carla Polanco met with Lead Teacher Shawn Northcraft in preschool room #7 to follow up on a Unusual Incident Report (UIR) called into Community Care Licensing on 1/12/24. The facility reported the UIR to Community Care Licensing within 24 hrs. A written UIR was submitted within 7 days, describing the specifics of the incident. During today's visit the facility was toured. Present were 15 children being supervised by 4 qualified staff members.

LPA conducted interviews and obtained information pertinent to the incident.

LPA interviewed a staff member (S1) who was present during the incident. S1 stated that on 1/12/24 a child in care was given a meal to which they are allergic to. S1 stated that the child's medication was retrieved from the office, and parent's and paramedics were immediately alerted.



LPA informed Lead Teacher Shawn Northcraft, that this report dated 1/18/24, documents a Type A citation, which is an immediate Health and Safety, or Personal Rights risk to persons in care. A separate 809-D page was issued for the deficiency.

Facility evaluation report was reviewed and discussed with Lead Teacher Shan Northcarft. Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal rights were provided.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Carla Polanco RiveraTELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 01/18/2024 02:39 PM - It Cannot Be Edited

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: TAFT SCHOOL
FACILITY NUMBER: 390319952

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/26/2024
Section Cited
CCR
101227(a)(7)(B)

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(a) In child care centers providing meals.....(7) Modified diets prescribed by a child's physician as a medical necessity shall be provided. (B) A child shall not be served any food to which the child's record indicates he/she has an allergy. This requirement was not met by evidenced by:
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Lead Teacher stated that the preschool Staff will be given information/training pertaining to the child's allergy. Facility will send LPA a statement signed by the preshool staff acknowlodging they are aware of the child's allergies, and that facility has a plan in place to prevent furure incidents.
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Upon interview with staff and review of the child's allergy list available at the facility, LPA learned that he child is allergic to Seafood. The child was accidentaly given a meal that had seafood as an ingredient while at the facility, which caused the child to have an allergic reaction.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Carla Polanco RiveraTELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2