393617385-4-15-2022-53-CC-LSCT-CDGR28-20220414123754

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393617385
Report Date: 04/14/2022
Date Signed: 04/15/2022 08:28:10 AM

Document Has Been Signed on 04/15/2022 08:28 AM - 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:	ACE TOTS PRESCHOOL		FACILITY NUMBER:	393617385
ADMINISTRATOR:	KHAN, NADIA		FACILITY TYPE:	850
ADDRESS:	7204 SHORELINE DRIVE		TELEPHONE:	(209) 330-1030
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95219
CAPACITY:	90	CENSUS: 22	DATE:	04/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Site Supervisor, Nadia Khan		TIME COMPLETED:	01:00 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	Licensing Program Analyst (LPA) Lauren Scott and Christopher Jackson met with Site Supervisor, Nadia Khan, for the purpose of an unannounced Annual inspection. LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. Facility days and hours of operation are Monday-Friday from 6:30 AM to 6:00 PM. Facility prepares meals on site and provides breakfast, lunch and snack. There were 22 children and 4 teachers present during today's inspection. LPA checked on annual fees and discussed with Site Supervisor the facility has a balance of $726. LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (wood chips) under the play structure. LPA reviewed the sign in/out book and observed that the children were not being signed in with full legal signatures. LPA reviewed 10 children’s and 4 staff files. LPA observed health screening reports with TB test and required immunization's. One staff was missing Tdap and MMR. At least one staff member present today has current Pediatric CPR and First Aid (exp. 10/2024). LPA observed AB1207 Mandated Reporter training certificates for all staff. The Site Supervisor was reminded to renew the course every 2 years through www.mandatedreporterca.com website. Site Supervisor was reminded that all adults 18 and over, 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. Report continues on 809-C.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-9269
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

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: ACE TOTS PRESCHOOL	FACILITY NUMBER: 393617385
	VISIT DATE: 04/14/2022

NARRATIVE

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This facility provides Incidental Medical Services (IMS). LPA reviewed medication was stored but did not include an unaltered label with child's name, name of prescribing physician or administration instructions. 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 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/inspection-process.

In the areas that were evaluated, deficiency was observed at the time of visit and cited on LIC 809D. Exit interview conducted and report was reviewed with the site supervisor. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Justin L Denton	TELEPHONE: (916) -92-9269
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/15/2022 08:28 AM - 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ACE TOTS PRESCHOOL	FACILITY NUMBER: 393617385
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(1)(B)

Health-Related Services

(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations of the medication stored on site, the licensee did not comply with the section cited above in LPA did not observe the medication to be stored in its original unaltered packaging, which poses/posed a potential health, safety or personal rights risk to persons in care
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	Site Supervisor will talk with parent to get proper documentation and send pictures that it is complete to LPA

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in LPA did not observe immunization records for 1 of the 4 staff files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	Site Supervisor states staff will bring them and she will send copies to LPA

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: Justin L Denton	TELEPHONE: (916) -92-9269
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/15/2022 08:28 AM - 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: ACE TOTS PRESCHOOL	FACILITY NUMBER: 393617385
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229.1(a)(1)

Sign In and Sign Out

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in children were being signed in and out without use of full legal signature by authorized pick up representative, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	Site Supervisor will advise parents to use full signature from here and out. Site Sueprvsior will send images to LPA

Type B

Section Cited

CCR

101439.1(c)

Infant Care Center Sleeping Equipment

(c) Floor mats or cots that meet the requirements of Section 101239.1(b) shall be provided for all infants who have the ability to climb out of a crib. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above in LPA observed sleeping mats were stacked on top of each other with individual sheets still on individual mats, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	Site Supervisor will remove sheets and place in cubbies after nap time. Site Supervsior will send image to LPA

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: Justin L Denton	TELEPHONE: (916) -92-9269
LICENSING EVALUATOR NAME: Lauren Scott	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC809 (FAS) - (06/04)

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