393607795-3-8-2023-53-CC-CPRA-CPQUCK-20230308142804

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393607795
Report Date: 03/08/2023
Date Signed: 03/08/2023 02:28:14 PM

Document Has Been Signed on 03/08/2023 02:28 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	MERLO PRESCHOOL		FACILITY NUMBER:	393607795
ADMINISTRATOR:	SOUPHONE LAEM		FACILITY TYPE:	850
ADDRESS:	1670 EAST SIXTH STREET		TELEPHONE:	(209) 933-7190
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY:	24	CENSUS: 10	DATE:	03/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Lead PM Teacher Souphone Laem		TIME COMPLETED:	03:00 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	On 3/8/23 Licensing Program Analyst Carla Polanco Rivera (LPA), met with Lead PM Teacher Souphone Laem, for the purpose of an unannounced Annual inspection. During today's inspection LPA conducted a tour of the facility. There were 10 children and four adult staff present during the inspection. LPA toured the facility inside and out. Facility days and hours of operation are Monday- Friday 8:00 AM-11:00 AM (AM class) and 12:00 PM-3:00 PM (PM class). LPA reviewed care and supervision of children, staffing ratios and first aid supplies, furniture, equipment, fire drills and drinking water. Facility has no children with medications at the moment. There are adequate toys and equipment available for children. Outdoor play area was toured, the play area for the children appeared to be in good repair, there is sufficient cushioning () under the play structure to prevent the fall. Toileting facilities were in operating, safe, and sanitary condition. LPA observed all required forms to be posted. Food is provided by the school and children are escorted to the cafeteria located on the same campus of Merlo Institute. Menus were posted and drinking water was readily available to children both indoors and outdoors. LPA reviewed the sign in/out book and observed that the children are properly signed in. Staff and children's records were reviewed. Each child's file contained an emergency card and consent for medical treatment. At least one staff member present today has current Pediatric CPR and First Aid certification (Exp. 06/2024). All staff currently employed with the facility have a criminal record clearance, mandated reporter certificates, and documentation of the educational background, training, and/or experience. LPA observed health screening reports with TB test and required MMR and TDAP vaccines for all staff members. Staff was reminded to renew the course every 2 years through www.mandatedreporterca.com website. Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Carla Polanco Rivera	TELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MERLO PRESCHOOL	FACILITY NUMBER: 393607795
	VISIT DATE: 03/08/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Facility has no children needing medication at the moment. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/(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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov.hone Laem. 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.

In the areas that were evaluated, no deficiencies were cited during the inspection. 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.

Exit interview conducted and report was reviewed with Lead PM Teacher, Souphone Laem. 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: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Carla Polanco Rivera	TELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023

LIC809 (FAS) - (06/04)

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