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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620341
Report Date: 06/22/2021
Date Signed: 06/22/2021 12:44:51 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: 0DATE:
06/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Debra KellerTIME COMPLETED:
12:45 PM
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On 6/22/21 Licensing Program Analyst (LPA) Aruna Sridharan met with Program Director Debra Keller regarding a room change for preschool. The facility previously operated out of A1 and now it is moved to D1. There are no children during the case management inspection as the facility will reopen on August 2nd, 2021.

The fire clearance was granted on 06/16/21. There are three sinks and two bathrooms. The playground is shared by kindergarten class. The facility has waiver for playground as posting. Room change does not affect the capacity. There are three sinks and two bathrooms. The carbon monoxide and smoke detected meet regulations.

The facility operates under state program with AM class from 8am to 11:30am and PM class from 12pm to 3:30pm. Breakfast and lunch is offered from the school district. Am class will be served breakfast and PM class will be served lunch.

Measurements for the D1 room are-
Room= 40X32=1280 sq.feet
Bathroom=14X9.5=133 sq.feet
Total classroom area=1147sq feet.

No deficiencies cited during this visit. The report was discussed with the director and copies are provided.

The license is granted for the room change from A1 to D1.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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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