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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393605949
Report Date: 09/20/2021
Date Signed: 09/20/2021 11:33:43 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:TRACY UNIFIED SCHOOL DISTRICT SOUTH/WEST PARK ELEMFACILITY NUMBER:
393605949
ADMINISTRATOR:GARCIA, ROCIOFACILITY TYPE:
850
ADDRESS:500 WEST MOUNT DIABLO AVETELEPHONE:
(209) 830-3355
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:32CENSUS: 0DATE:
09/20/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rocio GarciaTIME COMPLETED:
10:00 AM
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Application Specialist (AS) Alecia Sifuentes met with Licensee Representative, Rocio Garcia for the purpose of an announced case management inspection. Licensee requests a classroom change to classroom E101. Licensee is not making any changes to the capacity. The facility's hours of operation are Monday through Friday from 8:30 a.m. to 11:30 a.m. and 12:30 p.m. to 3:30 p.m. The granted fire clearance was received on 9/7/2021.

A health and safety inspection was conducted in all areas accessible to children. There is one preschool classroom. AS measured classroom E101. The total classroom space contains a total of 1,234.863 square feet, which will accommodate the current capacity of 32 preschool children. There are three toilets and three sinks available to children, and a separate staff restroom is available. A Shared Bathroom Waiver is on file. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). AS observed a functional carbon monoxide detector in the classroom. AS observed disinfectants are inaccessible and appropriately stored.

This facility provides Incidental Medical Services – IMS. For IMS information see 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 Licensee. Licensee was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

Effective today, 9/20/2021, AS will approve the facility’s classroom change for the preschool license.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
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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