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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607283
Report Date: 09/27/2023
Date Signed: 09/27/2023 04:16:36 PM


Document Has Been Signed on 09/27/2023 04:16 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ADAMS ELEMENTARY SCHOOLFACILITY NUMBER:
393607283
ADMINISTRATOR:TIM SWARTZFACILITY TYPE:
850
ADDRESS:6402 INGLEWOOD AVE.TELEPHONE:
(209) 953-3000
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:48CENSUS: 9DATE:
09/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Brenda De AlbaTIME COMPLETED:
04:30 PM
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On 09/27/23, Licensing Program Analyst (LPA), Elvira Sierra, met with Site Supervisor, Brenda De Alba for an unannounced annual inspection. Facility operates inside the Adam Elementary School Campus in two classrooms portable #41(Head Start Program) and classroom #1 (State) . Facility operates M-F part day from 08:00am to 11:00am and 12:00pm to 03:30pm in portable #41. Classroom #1 operates M-F 07:45am to 10:45am and 11:15am to 02:15pm. Facility follows school district calendar year. Staff criminal record clearances are conducted through the school district. Present in the facility were five staff supervising 9 children (3 staff with 8 children in portable #41 and two staff and one child in classroom #1).
Facility was inspected indoors and outdoors for Health and Safety hazards and the following was observed; Facility appeared clean including the carpets and floor. Classroom has age-appropriate toys and equipment that are in good repaired. Classroom is adequately ventilated/heated. Facility representative stated that currently there are no children that required medication. Cleaning products and toxins are maintained inaccessible to children. Restrooms are maintained
clean, in good repair and with adequate supplies. Staff use a separate restroom. Solid waste vessels have tight-fitting covers on, are in good repair. The isolation area for ill children is in the quiet area in the classroom and the use of the staff restroom if needed. Facility has a fire extinguishers that meets the minimum requirements, a working smoke, and a carbon monoxide detector. Outdoor play area is fenced for supervision. Facility has an approved waiver for bathroom and shared playground with elementary school students for classroom #1. Staff stated that play structure in the playground is not use by the preschool children due to not be age appropriate. LPA observed water accessible to children by pitcher/cups and water fountain.
First Aid Kit and Emergency supplies are available stored in the classrooms. Emergency Drill are conducted monthly and are properly logged. Facility provides full breakfast for the morning class and lunch for the afternoon class. All posting requirements has been met. LPA reviewed five children and four staff files. LPA observed current CPR/ First aid card for staff and facility sign in and out sheets were reviewed. ----Report continues on subsequent page 809C--
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ADAMS ELEMENTARY SCHOOL
FACILITY NUMBER: 393607283
VISIT DATE: 09/27/2023
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.


Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Report continues on subsequent page 809C--

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ADAMS ELEMENTARY SCHOOL
FACILITY NUMBER: 393607283
VISIT DATE: 09/27/2023
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative, Brenda De Alba.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC809 (FAS) - (06/04)
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