393620825-4-28-2022-53-CC-ASIS-CDWNJL-20220428103031

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393620825
Report Date: 04/28/2022
Date Signed: 04/28/2022 10:30:36 AM

Document Has Been Signed on 04/28/2022 10:30 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:	CAPC - ESCALON		FACILITY NUMBER:	393620825
ADMINISTRATOR:	ROBSON-BERMUDEZ, MICHELE		FACILITY TYPE:	850
ADDRESS:	1998 YOSEMITE AVENUE		TELEPHONE:	(209) 644-5311
CITY:	ESCALON	STATE: CA	ZIP CODE:	95320
CAPACITY:	22	CENSUS: 0	DATE:	04/28/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kim Ballard		TIME COMPLETED:	11:00 AM

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	Application Specialist (AS) Alecia Sifuentes and Licensing Program Analyst (LPA) Christopher Jackson met with Early Education Director, Kim Ballard for the purpose of an announced case management inspection. Licensee requests a classroom change to classroom HS1. Licensee is not making any changes to the capacity. The facility's hours of operation are Monday through Friday from 7:30 a.m. to 4:30 p.m. The granted fire clearance was received on 4/28/2022. INDOOR ACTIVITY SPACE: There is one preschool classroom (HS1). AS observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in the classroom. Medications will be stored in the kitchen in a locked box. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Director stated that a water dispenser will be provided. AS observed a functional carbon monoxide detector in the classroom. AS measured one classroom. The total classroom space contains a total of 971.85 square feet, which will accommodate Licensees current capacity of 22 preschool children. There are 2 toilets and 3 sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary. Report continues on LIC809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

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: CAPC - ESCALON	FACILITY NUMBER: 393620825
	VISIT DATE: 04/28/2022

NARRATIVE

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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall and separates the preschool yard from the elementary school yard. AS observed a sufficient amount of equipment and toys. The play structure includes a safety label, which designates use for children 2 to 5 years old. There are no bodies of water on the premises. There are shaded areas supplied by canopies and overhangs.

AS measured the outdoor activity space. The outdoor play area contains a total of 4,204.28 square feet, which will accommodate Licensees current capacity of 22 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Licensee 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.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Early Education Director, Kim Ballard.

Effective today, 4/28/2022, AS will approve the classroom change to preschool classroom HS1.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

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