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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393612153
Report Date: 12/06/2023
Date Signed: 12/06/2023 12:05:46 PM


Document Has Been Signed on 12/06/2023 12:05 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:WASHINGTON ELEMENTARYFACILITY NUMBER:
393612153
ADMINISTRATOR:KATHRYN BYERSFACILITY TYPE:
850
ADDRESS:1735 WEST SONORATELEPHONE:
(209) 933-7320
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY:24CENSUS: 17DATE:
12/06/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lynette PerezTIME COMPLETED:
12:30 PM
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On December 6th, 2023, at 9:15 AM, Licensing Program Analyst (LPA) David Nguyen met with Lead Teacher, Lynette Perez, for the purpose of an unannounced Annual inspection. The purpose of the unannounced annual inspection was explained. LPA was granted entrance by the Lead Teacher. Facility days and hours of operation are Monday through Friday from 7:45 am to 10:45 am. Facility provides breakfast, which is supplied by the school cafeteria, to childcare children in care. There were seventeen (17) children present during today's inspection. The Washington Elementary runs on a 10-month program from August to the end of May every year.

LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (wood chips) under the play structure. LPA reviewed the sign in/out book and observed that the children are properly signed in.

LPA reviewed children’s and staff files. All staff present during today's inspection have a fingerprint clearance. LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. LPA observed AB1207 Mandated Reporter training certificates for all staff. The Lead Teacher was reminded to renew the course every 2 years through www.mandatedreporterca.com website. Lead Teacher was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. Report continues on 809-C…(Page 2)

SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023
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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WASHINGTON ELEMENTARY
FACILITY NUMBER: 393612153
VISIT DATE: 12/06/2023
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(Page 2)

This facility is not currently providing Incidental Medical Services (IMS) because enrolled children needs no medications. 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

LPA discussed the Year-Round/Daily Reminder of Water Safety Requirements and Measures with Lead Teacher. LPA provided Lead Teacher the PIN 23-17-CCLD, the Year-Round and Daily Reminder of Water Safety Requirements and Measures. LPA discussed with Lead Teacher the importance of checking the premises for bodies of water daily prior children's arrival.

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. 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 the Lead Teacher. A notice of site visit was provided and must remain posted for 30 days. The Lead Teacher's signature on this form acknowledges receipt of this form. 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.

SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
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