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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620341
Report Date: 02/27/2020
Date Signed: 02/27/2020 04:20:04 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:GEORGE W. BUSH ELEMENTARY SCHOOL (PS)FACILITY NUMBER:
393620341
ADMINISTRATOR:KELLER, DEBRAFACILITY TYPE:
850
ADDRESS:5420 FRED RUSSO DRIVETELEPHONE:
(209) 933-7350
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:24CENSUS: 22DATE:
02/27/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Tamika FlutcherTIME COMPLETED:
04:30 PM
NARRATIVE
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At 12:10pm LIcensing Program Analystvt (LPA) met with Leona Fiddler, AM head teacher in room A1. The PM teacher Tamika Flutcher was in circle time with 21 children. There were two staff with Tamika. The facility was in compliance with ration, care and supervision. This facility abides to Title 5 regulations. This facility is located in elementary school campus. All staff are fingerprint cleared through the school district. The hours of operation for AM session is 8:00am to 11:30am and PM session from 12:00pm to 3:30pm. The facility provides snacks and meals from the school cafeteria.

Medications, disinfectants, cleaning solutions, and hazardous items were appropriately stored and inaccessible to children. First Aid was centrally located but inaccessible to children. Furniture, equipment, and play materials were in good condition. Playground equipment was free of loose and sharp parts. The areas under and around playground climbing equipment were cushioned with wood chips to absorb falls. Toileting facilities were in operating, safe, and sanitary condition which is shared with the elementary school.. Uncontaminated drinking water is readily available to children both indoors and outdoors through one faucet in classroom and four in the playground. LPA observed a current menu posted. LPA observed Sign In/Out Sheet with signatures, times, and dates. The facility conducts fire drills along with the school district per record the last drill was conducted 01/20. LPA observed a current children's roster.

LPA reviewed all three staff files. LPA reviewed documentation of qualifications including education and experience. Two out three staff were missing Mandated Reporter Training in their files. One staff had the mandated reporter training from an approved vendor. None of the staff had pediatric first aid training certificate on file. All staff currently employed with the facility have proof of immunizations.
Report continues on 809C page......
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
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: GEORGE W. BUSH ELEMENTARY SCHOOL (PS)
FACILITY NUMBER: 393620341
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/27/2020
Section Cited

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Every licensed child day care center ... more carbon monoxide detectors in the facility .... The department shall account for the presence of these detectors during inspections.
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This requirement was not met as evidenced by: LPA toured the classroom and did not observe a carbon monoxide dtetector. This is an immediate risk to the health and safety of children in care.
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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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: GEORGE W. BUSH ELEMENTARY SCHOOL (PS)
FACILITY NUMBER: 393620341
VISIT DATE: 02/27/2020
NARRATIVE
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LPA reviewed children’s files and observed that each child had their Identification/Emergency Information and the Consent for Medical Treatment form filled out and signed by their authorized representative, however PM 286 immunization record was missing for all children.

LPA also discussed Unusual Incident Reports (UIRs) and reporting requirements. LPA informed the Director that if any unusual incidents occur she must contact the Department within 24 hours and an UIR must be submitted with 7 day, describing the specifics to the incident.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regards to new regulations.
LPA discussed the Incidental Medical Services (IMS) policies with the licensee. The facility is currently providing IMS; however, LPA discussed the IMS policy. For IMS information see the Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and Medication Regulations 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), 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: www.ada.gov/childqanda.

Title 22 Deficiencies observed in the areas that were evaluated are recorded on 809D. LPA reviewed report and provided copies to the facility. An exit interview was conducted. Appeal Rights were provided and Notice of Site Visit posted and the director understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: GEORGE W. BUSH ELEMENTARY SCHOOL (PS)
FACILITY NUMBER: 393620341
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/13/2020
Section Cited

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Mandated Reporter: Effective January 1, 2018, all staff ..Homes are required to complete the Mandated Reporter Training..every 2 years. This requirement was not met as evidenced by;
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The two staff members do not have the Mandated Reporter certificate on file. This is a potential risk to the health and safety of children in care.
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Type B
03/26/2020
Section Cited

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At least one staff member who is trained in pediatric .. and pediatric first aid shall be onsite at all times when children are present. This requirement was not met as evidenced by;
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Upon record reviews of all three PM staff files, LPA did not observe pediatric first aid for any of the PM staff members. This is a potential risk to the health and safety of children in care.
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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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: GEORGE W. BUSH ELEMENTARY SCHOOL (PS)
FACILITY NUMBER: 393620341
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2020
Section Cited

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The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement was not met as evidenced by;
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Upon record review, LPA observed that PM 286 was missing in children's files. This is a potential risk to the health and safety of the children in care.
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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: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5