393610025-11-14-2019-53-CC-SWIS-BHWRQS-20191114121401

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393610025
Report Date: 11/14/2019
Date Signed: 11/14/2019 12:14:07 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:	WICKLUND CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	393610025
ADMINISTRATOR:	TREJO, STEPHANIE		FACILITY TYPE:	840
ADDRESS:	300 EAST LEGACY		TELEPHONE:	(209) 832-5834
CITY:	MOUNTAIN HOUSE	STATE: CA	ZIP CODE:	95391
CAPACITY:	70	CENSUS: 0	DATE:	11/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Stephanie Trejo		TIME COMPLETED:	12:25 PM

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Licensing Program Analyst (LPA) Stacey Williams met with Stephanie Trejo, Site Supervisor for the purpose of an annual random inspection. There were no children present during today’s inspection. Criminal record clearances were verified for staff present.

LPA toured the building including all activity and classroom spaces, restrooms, food service area and outdoor play area. Toxic and hazardous items are appropriately stored and inaccessible to children. Furniture and equipment are in good condition. The facility is located on an elementary school campus. The school’s play yard is utilized for outdoor play. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with materials to absorb the fall. Toileting facilities are in safe and sanitary condition. The food preparation space is free of litter. All food was protected against contamination. Trash cans containing solid waste had lids. Uncontaminated drinking water was readily available to children both indoors and outdoors. Menus were posted. Sign in and out sheets consisted of full legal signatures.

This facility is providing Incidental Medical Services-IMS and has a plan of operation in place. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s records. 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.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

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: WICKLUND CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 393610025
	VISIT DATE: 11/14/2019

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A sample of staff and children's records were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification that expires in April 2021. Information pertaining to authorized representatives, consent for medical treatment and a medical assessment forms were in in all child files. LPA reviewed staff records which included immunization records, mandated reporter completion certificate and documentation of the educational background, training, and/or experience.

Fire drill logs are being maintained. Fire drills are conducted every other month. Carbon monoxide detector was tested and found to be operable.

There were on Title 22 regulatory violations issued in the areas evaluated during today’s inspection.

This facility evaluation report was reviewed and discussed with the Site Supervisor. Site Supervisor was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. AB 2370 concerning lead exposure was discussed with the Director.

A notice of site visit was provided and should remain posted for a period of 30 days for parental review. Appeal rights were provided.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

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