393604402-5-30-2019-53-CC-SWIS-BCNNVT-20190530104828

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393604402
Report Date: 05/30/2019
Date Signed: 05/30/2019 10:48:33 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:	TULLY C. KNOLES PRESCHOOL		FACILITY NUMBER:	393604402
ADMINISTRATOR:	HAYES, JENNIFER		FACILITY TYPE:	850
ADDRESS:	6511 CLARKSBURG PLACE		TELEPHONE:	(209) 953-8776
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	48	CENSUS: 14	DATE:	05/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Jaime Funke		TIME COMPLETED:	11:00 AM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Stacey Williams met with Jaime Funke, School Readiness Specialist for the purpose of conducting an unannounced random annual inspection. LPA toured the facility including all activity and classroom spaces, restrooms, and outdoor play areas. Appropriate ratio and care and supervision were observed during today's inspection. Census included 14 preschool children supervised by three staff. School Readiness Specialist was reminded never to exceed the conditions, limitations and capacity specified on the license. The facility operates in classroom 26 on the elementary school grounds. There are two half day programs. Hours of operation are Monday through Friday, 8:00 AM-11:00AM and 12:00 PM- 3:00 PM.

Classroom appeared clean including the carpets and floor. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under the climbing equipment are cushioned with enough material to absorb a fall. There are trees providing shade. Uncontaminated drinking water was readily available to children both indoors and outdoors. There are no firearms or bodies of water on the premises, and the facility has one functioning carbon monoxide detector. Trash cans containing solid waste had lids. LPA observed the classroom to have a first aid kit with the appropriate supplies. Classroom menu was posted. The facility provides breakfast and snack. Children eat breakfast and snack in the classroom. Required licensing documentation is posted on the bulletin board. LPA reviewed the sign/in-sign/out sheet. Toileting facilities are in safe, sanitary, and operating condition and there are enough sinks and toilets for the children in care. All cleaning supplies and medications were stored inaccessible to children in care and located in locked cabinets.

Report continues on subsequent page, LIC 809C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797-
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: TULLY C. KNOLES PRESCHOOL	FACILITY NUMBER: 393604402
	VISIT DATE: 05/30/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Selected staff and children's records were reviewed. All required documentation was observed in the files. Criminal Record clearances are associated to the facility license through the school district. At least one staff member present today has current Pediatric CPR and First Aid certification that expires November 2020. LPA observed a current children's roster and fire drill log with the last one conducted in May 2019.

Incidental Medical Services-IMS was discussed. The facility has a case plan on file. LPA discussed IMS services and the requirement to update the plan of operation. For additional IMS information, LPA advised review of Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

This facility evaluation report was reviewed and discussed with Jaime Funke, School Readiness Specialist. A notice of site visit was provided and should remain posted for a period of 30 days for parental review. LPA encouraged School Readiness Specialist to visit the department’s website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation. The implementation of AB 2370, lead exposure was discussed. A copy of this report will remain on file for a period of 3 years for public review upon request. Appeal rights were discussed and provided.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797-
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2