393607983-3-9-2020-53-CC-GSIH-BMJNBB-20200309101851

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393607983
Report Date: 03/09/2020
Date Signed: 03/09/2020 10:18:56 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:	SMITH, GLORIA		FACILITY NUMBER:	393607983
ADMINISTRATOR:	SMITH, GLORIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 956-9334
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	14	CENSUS: 5	DATE:	03/09/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Gloria Smith		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA) Gagandeep Singh met with licensee, Gloria Smith, for an annual inspection. The purpose of the inspection was explained. Licensee lives in a single family home. Present, there are five children ( four pre school age, one school age) in care. All adults living or working in the home have criminal background check on file. Licensee is operating within the capacity of this date. LPA inspected the day care areas with the licensee. Day Care Areas: Living Room, Bathroom in Hallway, Kitchen, Dining area and Family room. Off limit areas: All bedrooms, Garage and Backyard. There is no pool, spa or any other body of water in the house. Pool in the backyard has been removed. As per licensee, there is no firearm or weapon in the house. LPA observed multiple smoke detectors and fire extinguishers in the house. The house has fire alarm installed. All the cleaning supplies, poisons and other chemicals are stored inaccessible to the children. Fireplace is barricaded. The house is in good repair and free of hazards with proper temperature and ventilation. There is carbon monoxide detector and working telephone available in the house. There is a variety of age appropriate toys in the house. LPA review the facility records. LPA observed licensee has all of the required documents posted and are visible for public. LPA observed licensee has a log in place for fire and emergency drills. Per log, last drill was conducted on February 5, 2020. LPA reviewed all present children's records. LPA reviewed the identification and emergency information form for every child for proper names and numbers filled. Licensee has record of immunization of each child on file. LPA observed licensee has signed Acknowledgement of receiving licensing reports form in each child’s file. Licensee has record of training of preventive health and CPR card valid until August 2020. See next page for continuation ..............

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020

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: SMITH, GLORIA	FACILITY NUMBER: 393607983
	VISIT DATE: 03/09/2020

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Licensee is aware that a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles. Licensee’s record of immunization was checked during previous inspections. Licensee is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed licensee has the completion certificate on file. Per certificate, licensee completed the training in August 2019.

LPA discussed the effects of lead exposure and a brochure was provided to licensee to handout to the parents. LPA encourage the licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020

LIC809 (FAS) - (06/04)

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