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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393608171
Report Date: 08/29/2019
Date Signed: 08/29/2019 12:03:18 PM

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:MADISON ELEMENTARY STATE PRESCHOOLFACILITY NUMBER:
393608171
ADMINISTRATOR:SCHROEDER, JOSHUAFACILITY TYPE:
850
ADDRESS:2939 MISSION RD.TELEPHONE:
(209) 466-3122
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:24CENSUS: 18DATE:
08/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Danielle AndersonTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Charlotte Baney and Chayntel Hunter met with Teacher, Danielle Anderson for the purpose of an unannounced Annual/Random inspection. LPAs observed care and supervision of 18 preschoolers supervised by 6 staff. LPAs toured the facility inside and out. LPAs observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. Facility days and hours of operation are Monday-Friday from 8:00 AM to 11:00 AM and 12:00 PM to 3:30 PM. There is a waiver for the bathroom and shared playground use posted at the facility.

The AM class is served breakfast and the PM class is served lunch, and all food is received from the cafeteria. LPAs reviewed care and supervision of children, staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPAs observed all required forms to be posted. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, there is sufficient cushioning (bark) under the play structure.

LPAs reviewed the sign in/out book and observed that the children are properly signed in. All staff present during today's inspection have a fingerprint clearance. LPAs observed required MMR, Tdap, and Influenza immunization. All staff members present today has current Pediatric CPR and First Aid. LPAs observed AB1207 mandated reporter training certificates for all staff.

Incidental Medical Services (IMS) policy was discussed. Facility does not have any children that require an IMS plan at time of inspection.

This facility evaluation report was reviewed and discussed with the Teacher. An exit interview was conducted. A Notice of Site Visit was provided and posted.

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

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019
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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