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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393611181
Report Date: 12/05/2019
Date Signed: 12/05/2019 11:51:37 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:STOCKTON UNIFIED SCHOOL DISTRICT-WILSON STATEFACILITY NUMBER:
393611181
ADMINISTRATOR:AGBULOS-LOERA, SUZANNEFACILITY TYPE:
850
ADDRESS:150 E. MENDOCINOTELEPHONE:
(209) 933-7325
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:24CENSUS: 0DATE:
12/05/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Starlyn BrownTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Charlotte Baney met with Starlyn Brown, Teacher, for the purpose of an unannounced annual random inspection. The program has a morning class 8:00am-11:30am and a afternoon class 12:00pm-3:30pm. this is a SUSD State Pre School.

LPA toured the facility inside and out for a health and safety inspection. PHYSICAL PLANT-The facility appeared orderly and suitable for children. All cleaning supplies and hazardous items are stored in a latched cabinet, inaccessible to children. Outdoor activity space and equipment was in good repair. Restrooms were sanitary and in operating condition. Storage containers for solid waste had lids. Drinking water was readily available inside and outside. FACILITY ADMINISTRATION- All staff present today had criminal background check clearances and/or exemptions though SUSD. EVALUATION OF CARE AND SUPERVISION- Capacity and ratio requirements were being met. FACILITY RECORDS REVIEW- Children’s records include information pertaining to their authorized representative and a medical assessment. Staff records contain a current CPR/First Aid, health screening and the educational background, training, and/or experience.

LPA advised the teacher to visit the licensing website at www.ccld.ca.gov for current forms, laws, regulations and legislation.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Charlotte BaneyTELEPHONE: (916) 216-7791
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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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