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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393612197
Report Date: 05/12/2023
Date Signed: 05/12/2023 12:24:38 PM


Document Has Been Signed on 05/12/2023 12:24 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:LINCOLN ELEMENTARY PRESCHOOLFACILITY NUMBER:
393612197
ADMINISTRATOR:MICHELLE DENNERTFACILITY TYPE:
850
ADDRESS:6910 GETTYSBURG PLACETELEPHONE:
(209) 953-8651
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:24CENSUS: 17DATE:
05/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rena DameleTIME COMPLETED:
01:00 PM
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On 05/12/23 Licensing Program Analyst (LPA) Elvira Sierra met with facility representative, Rena Damele for the purpose of an unannounced annual inspection. Facility representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility operates M-F, during the school calendar year, between 08:00 am to 11:00am and from 12:00pm to 3:00 pm in the Lincoln Elementary school grounds in classroom # 50. Census include 17 children being supervised by three staff members. All staff members present today had criminal background record clearance on file with the District Office.

LPA conducted a health and safety inspection in all areas accessible to children and the following was observed; Licensing required postings were observed by the main entrance of the classroom. Per facility representative there are no poisons on the premises. Toxic and hazardous items were observed inaccessible to children. Furniture and equipment in the classroom are age appropriate and in good repair. The floors appeared clean throughout the facility. Per facility representative there are no firearms on the premises and no bodies of water were observed. Facility has at least one functioning smoke carbon monoxide detector and a fire extinguisher that meets Fire Marshall standards. Toileting facilities are in safe, sanitary, and operating condition. Program provides breakfast for the morning class and lunch for the afternoon class. Menus and daily activity schedule were posted in the classroom. Outdoor play area is free from dangerous conditions. Water is readily available indoor and outdoor by water fountain and also bottle water if needed. Sign in/out binders were reviewed.

Five children files were reviewed. Each child's file contained the required documentation by regulation. Three staff file was reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. Fire drill are conducted monthly in conjunction with the elementary school.

Report continues on subsequent page 809C--

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: LINCOLN ELEMENTARY PRESCHOOL
FACILITY NUMBER: 393612197
VISIT DATE: 05/12/2023
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Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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



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/process.

A notice of site visit was posted and must remain posted for 30 days. Exit interview conducted and the report was provided and reviewed with the facility representative, Rena Damele.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
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