393605949-11-8-2019-53-CC-SWIS-BHQTMS-20191108135138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393605949
Report Date: 11/08/2019
Date Signed: 11/08/2019 01:51:44 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:	TRACY UNIFIED SCHOOL DISTRICT SOUTH/WEST PARK ELEM		FACILITY NUMBER:	393605949
ADMINISTRATOR:	SOTO-BARAJAS, RAMONA		FACILITY TYPE:	850
ADDRESS:	501 W. MT. OSO AVE.		TELEPHONE:	(209) 830-3335
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	32	CENSUS: 0	DATE:	11/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Tasha Mathews		TIME COMPLETED:	02:10 PM

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Licensing Program Analyst (LPA) Stacey Williams met with Tasha Mathews , Preschool Clerk, for the purpose of an unannounced random annual inspection. The preschool conducted parent – teacher conferences today, therefore there were no children present during today’s inspection. The facility operates two half day programs in classroom D-101 of South /West Park Elementary School. Facility hours of operation are Monday through Friday, 8:30AM- 11:30 AM and 12:30 PM- 3:30 PM.

LPA toured the facility including all activity and classroom space, restroom, and outdoor play area. Classroom appeared clean including the carpets and floor. Playground equipment and surfaces are free of loose or sharp parts. Uncontaminated drinking water was readily available to children both indoors and outdoors. The facility has a functioning internal carbon monoxide and smoke detector that is maintained by the school district. Trash cans containing solid waste had lids. Classroom menu was posted. The facility provides breakfast for the morning program and a snack for the afternoon program. Required licensing documentation is posted on the side wall in the classroom. LPA reviewed the full signatures for parent sign in/out sheets. LPA observed a current children's roster and fire drill log with the last one conducted in October 2019. Toileting facilities are in safe, sanitary, and operating condition and there are enough sinks and toilets for the children in care. All cleaning supplies 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: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: TRACY UNIFIED SCHOOL DISTRICT SOUTH/WEST PARK ELEM	FACILITY NUMBER: 393605949
	VISIT DATE: 11/08/2019

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Selected staff and children's records were reviewed, and all required documentation was observed. Emergency information and medical assessments were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification that expires November 2019. Staff criminal record clearances are conducted through the school district. Staff records contain health screenings and documentation of immunizations. LPA was informed that mandated reporter certificates are kept at the main district office.

Incidental Medical Services-IMS was discussed. 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.

There were no Title 22 deficiencies cited in the areas evaluated during today's inspection.

This facility evaluation report was reviewed and discussed with the Preschool Clerk. A notice of site visit was provided and should remain posted for a period of 30 days for parental review. LPA encouraged Preschool Clerk 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: 11/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019

LIC809 (FAS) - (06/04)

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