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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607697
Report Date: 05/02/2019
Date Signed: 05/02/2019 11:34:36 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:SOUTH SCHOOL CHILD DEVLOPMENT CENTERFACILITY NUMBER:
393607697
ADMINISTRATOR:ARENS, JANFACILITY TYPE:
840
ADDRESS:500 WEST MOUNT DIABLOTELEPHONE:
(209) 834-1725
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:70CENSUS: 0DATE:
05/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Christy ZillerTIME COMPLETED:
11:45 AM
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Licensing Program Analyst, Mary Ponce met with director Christy Ziller for an unannounced annual inspection. LPA toured the facility including all activity/classroom areas, food service area, restrooms and outdoor play areas. There were no children present during today's inspection; however director stated that at most, the program runs 55 children in the afternoon with 6 staff members present. LPA observed the tracking list that documents each child present in the program on any given day to verify.

LPA reviewed the sign/in-sign/out sheet as required for school age component, and at least one staff member present today has current CPR/ First aid certificate that expires 11/30/2020. All staff currently employed with the facility has a criminal record clearance, poisons are locked and there are no firearms or bodies of water on the property.

LPA observed that medication is centrally stored and out of reach of children. The medication is properly labeled.

LPA reviewed Department’s inspection authority and discussed with designee any changes that may occur regarding the Director or an employee acting in director's absence must be reported to department within 10 working days.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regards to new regulations.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7813
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
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: SOUTH SCHOOL CHILD DEVLOPMENT CENTER
FACILITY NUMBER: 393607697
VISIT DATE: 05/02/2019
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LPA conducted 7 file reviews for school age children in care and observed that each child has their Emergency card, Consent for Medical Treatment, and Personal Rights signed by their legal representative.

LPA reviewed 6 staff files and observed that staff are immunized for Measles and Pertussis. LPA also observed the Employee Rights signed, and that all staff have the proper education to supervise children in care.


The center provides Incidental Medical Services (IMS) and have an IMS plan on file at the Sacramento Regional Office.

During today's inspection there were no deficiencies cited. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7813
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
LIC809 (FAS) - (06/04)
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