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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616650
Report Date: 08/13/2019
Date Signed: 08/13/2019 11:30:07 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 PARKS & REC., KIDS ZONE - NEIL HAFLEYFACILITY NUMBER:
393616650
ADMINISTRATOR:LOMA, VICTORIAFACILITY TYPE:
840
ADDRESS:849 NORTHGATE DRIVETELEPHONE:
(209) 456-8600
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:60CENSUS: 0DATE:
08/13/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Chris BritenbucherTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Christopher Jackson met with the Recreation coordinators Chris Breitenbucher for the purpose of a room change on the Elementary School Campus of Neil Hafley. LPA conducted a health and safety inspection of the room. Today's census was zero children in attendance. Center has requested a move from room #35 to room #29.

LPA toured all areas of the room that will be utilized by children in care. LPA observed licensing postings, child sized furnishings and activities. LPA observed a First Aid kit in the room. Recreation Coordinator stated the facility will provided an afternoon snack. LPA observed a working mini refrigerator in the room, which will be used to store food items. LPA observed the restroom area to be located out of the classroom and down the hall to the north, west of the campus. LPA discussed 100% supervision when transitioning children to the restroom area.

According to Title 22, Division 12, Sections 101538.2 (c) & 101538.3 (c), the school-age program is exempt from the indoor and outdoor square footage as well as the restroom requirements.

The center was previously licensed to operate in room #35 and will now be operating in room #29.

As of 08/13/19 LPA is approving the room for use.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
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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