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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616646
Report Date: 10/04/2021
Date Signed: 10/04/2021 11:01:58 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:MANTECA REC.&COMM. SVCS. KIDS ZONE WALTER WOODWARDFACILITY NUMBER:
393616646
ADMINISTRATOR:BASYE, KATHELEENFACILITY TYPE:
840
ADDRESS:575 TANNEHILL DRIVETELEPHONE:
(209) 456-8600
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY:90CENSUS: 0DATE:
10/04/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Victoria Loma, Jennifer HooperTIME COMPLETED:
10:00 AM
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Application Specialist (AS) Alecia Sifuentes met with Recreation Coordinator, Victoria Loma and Program Coordinator, Jennifer Hooper for the purpose of an announced case management inspection. Licensee requests a classroom change to classroom 718. Licensee is not making any changes to the capacity. The facility's hours of operation are Monday through Friday from 11:15 a.m. to 6:00 p.m. AS observed the elementary schools fire clearance is on file as well as the principal letter granting permission for the program to utilize all areas of the school.

A health and safety inspection was conducted in all areas accessible to children. There is one school-age classroom. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, AS did not take measurements. The children will use the school’s restrooms, and a separate private restroom for the staff. Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

This facility provides Incidental Medical Services – IMS. 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.

This facility evaluation report was reviewed and discussed with Licensee. Licensee was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

Effective today, 10/4/2021, AS will approve the facility’s classroom change for the school-age license.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
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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