393616650-3-10-2020-53-CC-ASIS-BML2EJ-20200310172000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393616650
Report Date: 03/10/2020
Date Signed: 03/10/2020 05:20:22 PM

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 HAFLEY		FACILITY NUMBER:	393616650
ADMINISTRATOR:	LOMA, VICTORIA		FACILITY TYPE:	840
ADDRESS:	849 NORTHGATE DRIVE		TELEPHONE:	(209) 456-8600
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	60	CENSUS: 18	DATE:	03/10/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Biannca Perez		TIME COMPLETED:	05:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Alecia Sifuentes met with Supervisor Brandy Clark, Program Coordinator Jennifer Hooper, and Teachers, Biannca Perez and Sophia Gunzo for the purpose of an unannounced annual random inspection. Census included eighteen children being supervised by two staff members. Facility hours of operation are Monday through Friday from 6:30 a.m. to 8:45 a.m. and 12:30 p.m. to 6:00 p.m.

LPA toured all activity and classroom spaces, restrooms, and outdoor play areas. Medications are stored appropriately and are inaccessible to children. Toxic and hazardous items are located in a locked cabinet under the sink and inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment is cushioned with bark to absorb the fall. Toileting is located outside of the facility on the elementary school campus. Toilets are in safe, sanitary and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides morning snack and afternoon snack. Menus were posted and drinking water was readily available to children both indoors and outdoors. LPA observed full legal signatures while reviewing the sign-in and sign-out sheet.

Two staff and five children's records were reviewed. Each child's file contained an emergency card and a consent for medical treatment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 8/3/2020). All staff currently employed with the facility have a criminal record clearance, health screening report, and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector.

Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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: MANTECA PARKS & REC., KIDS ZONE - NEIL HAFLEY	FACILITY NUMBER: 393616650
	VISIT DATE: 03/10/2020

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The facility's Plan of Operation is located in the facility file. Incidental Medical Services (IMS) is provided by this facility. 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 athttp://www.ada.gov/childqanda.htm.

This facility evaluation report was reviewed and discussed with Recreational Coordinator. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Director was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov.

Title 22 Deficiencies have been cited on the attached LIC 809D. A violation regarding S1 not obtaining a criminal record clearance prior to working at the facility warrants a civil penalty of $500.00 and is hereby assessed, see LIC421BG. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files. This report was reviewed and discussed with licensee. A notice of site visit and appeal rights were provided.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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: MANTECA PARKS & REC., KIDS ZONE - NEIL HAFLEY	FACILITY NUMBER: 393616650
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/11/2020 Section Cited	1 2 3 4 5 6 7	(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not ensure that S1 was fingerprint cleared and associated prior to working in the facility which poses an immediate Health, Safety, and Personal Rights risk to persons in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7

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

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

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