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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390320836
Report Date: 01/09/2020
Date Signed: 01/09/2020 01:22:02 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:ST. BASIL PRESCHOOLFACILITY NUMBER:
390320836
ADMINISTRATOR:WILLIAMS, TAMARAFACILITY TYPE:
850
ADDRESS:920 W. MARCH LANETELEPHONE:
(209) 478-5252
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:60CENSUS: 38DATE:
01/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Akane GreeneTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gagandeep Singh met with new director, Akane Greene, for a case management inspection regarding an unusual incident. Purpose of the inspection was explained. The facility self reported that on December 13, 2019, two children were playing in the classroom. After one child rejected to share the toy, the other child pretended to be unresponsive for a ten to fifteen seconds.

During today’s inspection, LPA interviewed the director, who was the assigned teacher in the classroom where the incident happened. Per director, director was with the children. Per director, after a child refused to share a toy, a child started to fell backward with the eyes rolled over. Per director, because the director was sitting right next to the children, director prevented the fall and catch the child. Per director, as director catch the child, the child was not responding, but when director asked other teacher to call 911, the child started to respond and hugged the director. Per director, parents were informed about the incident and parent reported that this child does this behavior at home also. Per director, the child attended the day care until the winter break, which was starting from December 20, 2019. Per director, the facility started the after the break in this week and the child has not started to come yet, but still is enrolled. Director stated that when the family brings the child to the facility, director will ask the family to provide documentation of family getting the physical check of the child by physician.

Through the interview, it was observed the facility followed the emergency procedures. No violations were observed. Copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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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