<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604413
Report Date: 04/27/2022
Date Signed: 04/27/2022 12:35:48 PM


Document Has Been Signed on 04/27/2022 12:35 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:WEBER TECHNICAL INSTITUTE PRESCHOOLFACILITY NUMBER:
393604413
ADMINISTRATOR:MOMBERG, KNUTEFACILITY TYPE:
850
ADDRESS:302 W.WEBER, CLASSROOM ATELEPHONE:
(209) 467-7054
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY:44CENSUS: 24DATE:
04/27/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Carol MarquezTIME COMPLETED:
01:00 PM
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) Lauren Scott and Christopher Jackson met with Carol Marquez to follow up on the Unusual Incident Report (UIR) submitted to Community Care Licensing on April 14, 2022. During today's visit the facility was toured.

Licensing staff interviewed the Staff #1 (S1) who was present during the incident.

LPA learned that the incident occurred on 4/14/22, during the transition from outside to inside the classroom. Two staff were supervising 13 children. Staff #2 (S2) was assisting 2 children, while S1 had 11 children lined up to go inside. Once S1 and S2 were inside the classroom, with the door closed, a recount was conducted and staff noticed child #1 (C1), was left outside unattended. When S2 opened the outside door, C1 was under the slide. C1 returned to inside the classroom.

A Type A deficiency was cited on the subsequent page (809-D) of this report.

Facility evaluation report was reviewed and discussed with the lead teacher. 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.
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-9269
LICENSING EVALUATOR NAME: Lauren ScottTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022
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 04/27/2022 12:35 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833


FACILITY NAME: WEBER TECHNICAL INSTITUTE PRESCHOOL
FACILITY NUMBER: 393604413

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2022
Section Cited

1
2
3
4
5
6
7
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: Licensing staff learned that Child#1 was left without staff supervision for approximately 1 minute on 4/14/2022.
8
9
10
11
12
13
14
A final recount of the children is conducted before shutting the door as well as a visual sweep.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Justin L DentonTELEPHONE: (916) -92-9269
LICENSING EVALUATOR NAME: Lauren ScottTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2