393615675-1-28-2025-53-CC-ESIA-DDCUVV-20250128145547

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393615675
Report Date: 01/28/2025
Date Signed: 01/28/2025 02:55:53 PM

Document Has Been Signed on 01/28/2025 02:55 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:	MAXINE HONG KINGSTON ELEMENTARY		FACILITY NUMBER:	393615675
ADMINISTRATOR/ DIRECTOR:	DOMINIQUE BROWN		FACILITY TYPE:	850
ADDRESS:	6324 ALTURAS AVENUE		TELEPHONE:	(209) 933-7493
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 20	CENSUS: 12	DATE:	01/28/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:15 PM
MET WITH:	Sandra Sanchez		TIME VISIT/ INSPECTION COMPLETED:	03:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/28/25, Licensing Program Analyst (LPA) Elvira Sierra met with facility representative, Sandra Sanchez 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 inside Maxine Hong Kingston Elementary school grounds in classroom # 1. Facility is currently operating M-F part day from 08:00am to 11:00am and 12:00pm to 03:00pm.Facility follows school calendar year. Per facility representative all staff present on today's inspection have criminal record clearances on file with the District Office. Present at the facility were 3 staff members supervising 12 children. LPA conducted a health and safety inspection in all areas accessible to children and the following was observed; Appropriate ratio and care and supervision were observed during today's inspection. Classroom is adequately ventilated/heated. LPA observed age-appropriate toys and equipment that are in good repair. Cleaning supplies were observed accessible to children. LPA discussed with facility representative that all cleaning supplies must be stored inaccessible to the children. LPA observed functioning carbon/monoxide detectors and a 2A10BC fire extinguisher that follows California State Fire Marshall standards. Per facility representative there are no poisons on the premises and no bodies of water were observed. The floors appeared clean throughout the facility. Toileting facilities were observed in safe, sanitary, and operating condition. First Aid Kit and Emergency supplies are available and stored inaccessible to children. There are no children that required medication at this time. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Facility representative stated that playground equipment is not use by the preschool children because is age inappropriate. Facility representative stated that staff makes sure children don't use the equipment by position themselves around the equipment and providing toys and tricycles for the children. Outdoor space has an alternate schedule to be shared with elementary school children. Facility has a waiver on file. Drinking water is readily available indoor and outdoor by water fountain or bottle waters/disposable cups. Sign in/out sheets were reviewed. Facility provides breakfast for the morning class and lunch for the afternoon class. Menus and daily activity schedule were observed posted in the classroom. Report continues on subsequent page 809C---

Bettina Engelman	TELEPHONE: (916) 263-5820
Elvira Sierra	TELEPHONE: (916) 216-8826
	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

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: MAXINE HONG KINGSTON ELEMENTARY	FACILITY NUMBER: 393615675
	VISIT DATE: 01/28/2025

NARRATIVE

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Fire drills are conducted jointly with the elementary school children once a month and are properly log. Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
Testing Expiration Date: 01/24/28.
Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.
See page 809 D for deficiency cited today under Title 22 Regulations. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report and Appeal of Rights were reviewed and provided to facility representative, Sandra Sanchez.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 01/28/2025 02:55 PM - It Cannot Be Edited

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: MAXINE HONG KINGSTON ELEMENTARY	FACILITY NUMBER: 393615675
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

101238.4(d)

Storage Space

(d) Combustibles, cleaning equipment and cleaning agents shall be stored in an area separate from food supplies in a locked cabinet or in a location inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the facility did not comply with the section cited above by having unlock bottom cabinet with celaning supplies acessible to the children, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/31/2025
	Plan of Correction
1 2 3 4	Facility representaive stated that she wil request a child lock for the cabinet and/or will remove the cleaning from the bottom cabinet.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Bettina Engelman	TELEPHONE: (916) 263-5820
Elvira Sierra	TELEPHONE: (916) 216-8826
	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC809 (FAS) - (06/04)

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