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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620851
Report Date: 12/05/2019
Date Signed: 12/05/2019 12:42:59 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:SUSD - CLEVELAND ELEMENTARY SCHOOL (PS)FACILITY NUMBER:
393620851
ADMINISTRATOR:MOHAMMADKHAN, HEIDIFACILITY TYPE:
850
ADDRESS:20 E. FULTONTELEPHONE:
(209) 933-7165
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY:20CENSUS: 14DATE:
12/05/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Joanna GamaTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Charlotte Baney and met with Joanna Gama, Teacher, for an unannounced annual/random inspection. Fourteen (14) preschool-age children and 2 staff members were present. The program operates part-time classes 8-11:30 a.m. and 12-3:30 p.m.
A tour of facility was conducted inside and outside. There was sufficient staff to meet ratio requirements. Drinking water is available both inside and outside. Cleaning solutions and other items that are dangerous to children are kept in a safe place inaccessible to children. Adequate supervision was provided during today’s visit.
The program provides breakfast for the morning class and lunch for the pm session. Menus are posted. LPA observed food preparation areas to be clean and sanitary. Storage containers for solid waste have tight fitting covers. Sign in/sign out sheets are maintained. All staff have criminal record clearance through the school district. Emergency information and medical assessments were reviewed for some children. Staff records contain health screenings and documentation of immunization's to meet SB 792. At least one staff member has a current CPR/First Aid Certificate.
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 Child Care Centers Sections 101173 and 101226.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

NO DEFICIENCIES were observed in the areas that were evaluated today. An exit interview was conducted. A Notice of Site Visit was posted.

SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Charlotte BaneyTELEPHONE: (916) 216-7791
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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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