393620823-1-10-2020-53-CC-CJAN-BKPUTB-20200110145139

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393620823
Report Date: 01/10/2020
Date Signed: 01/10/2020 02:51:46 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:	CAPC - GOLDEN WEST		FACILITY NUMBER:	393620823
ADMINISTRATOR:	SILVA, REBECCA		FACILITY TYPE:	850
ADDRESS:	1031 NORTH MAIN STREET		TELEPHONE:	(209) 644-5311
CITY:	MANTECA	STATE: CA	ZIP CODE:	95336
CAPACITY:	24	CENSUS: 15	DATE:	01/10/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Julie Davis		TIME COMPLETED:	03:00 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) Christopher Jackson conducted an unannounced random annual inspection today. LPA met wth site supervisor Julie Davis. Program manager Renee Sandez arrived shortly into today's inspection. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. The program operates tow part day sessions. The first session is from 8:00 AM to 11:30 AM and the second session is from 12:30 PM to 3:30 PM. A tour of the facility was conducted inside and outside. The following areas are in compliance during the inspection. There are no bodies of water. Firearms and ammunition are not on the premises. LPA did not observe any poisons in the facility. Disinfectants, hazardous items and medications are inaccessible to children in care. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted and documented. Carbon Monoxide and smoke detectors were present. LPA observed a working fire extinguisher in the facility. The playground equipment and outdoor activity space is maintained and in good condition. LPA observed a sing in the structure area noting equipment is recommended for children ages two to 12 years old. Wood chips are being used as cushioning around the climbing equipment and the level is sufficient to absorb a fall. Children's toilets, hand washing facilities are sanitary. Floors are clean and free of debris. Food preparation area is clean. The site supervisor stated the facility provides an AM and PM snack only and the food is brought in by Creative a third party vendor. Trash containers for solid waste are covered and all food or beverages are stored in covered containers and labeled. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Electronic sign in/sign out are utilized and maintained. During today's inspection at least one staff on site held a current First Aid/CPR keeping the facility in compliance. LPA observed CPR to expire on 02/21. A file review was conducted for four of the children enrolled during today's inspection. LPA observed the files to be in compliance according to Title 22 regulations. LPA conducted a records review for the three staff present during today's inspection. LPA observed the files to in compliance with Title 22 regulations. Report Continues on 809-C

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020

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: CAPC - GOLDEN WEST	FACILITY NUMBER: 393620823
	VISIT DATE: 01/10/2020

NARRATIVE

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This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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.

LPA provided an updated copy of the new immunization records card to be used by the facility. LPA also provided a copy of the Effects of Lead handout. LPA did observe the lead pamphlet already posted in the parent board.

LPA conducted an observation of the outside play time. LPA observed staff positioned aroud the play to ensure children are kept in supervision at all times. LPA observed staff engagement with the children and observed the speaking in appropriate tones and problem solving with children needing support.

LPA discussed the Mandated Reporter Training with site supervisor. LPA reminded site supervisor of the two renewal requirement for the training. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English. LPA observed completion certificate in all staff files reviewed during today's inspection.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the the site supervisor can obtain updated licensing information, new regulations and access forms. LPA advised the site supervisor of their responsibility to stay current in regards to new regulations.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the site supervisor and provided copies. An exist interview was conducted. LPA observed the Notice of Site Visit posted and the site supervisor understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020

LIC809 (FAS) - (06/04)

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