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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620958
Report Date: 11/26/2019
Date Signed: 11/26/2019 12:07:17 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:CAP EARLY HEAD START PROG.-ST. MARY'SFACILITY NUMBER:
393620958
ADMINISTRATOR:LORMIE ESCORPISOFACILITY TYPE:
850
ADDRESS:545 WEST SONORA STREETTELEPHONE:
(209) 242-9540
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY:16CENSUS: 9DATE:
11/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Marisela GonzalezTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPAs) Charlotte Baney and Chris Jackson met with the Site Supervisor Marisela Gonzalez for an annual/random visit. LPA toured the facility, including all activity/classroom areas, the isolation area, food service area, rest-room and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications and first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions.

LPA observed all required forms to be posted. During today's visit LPA did not observe medication in the facility. First aid supplies were available. There are adequate toys and equipment available for children. The rest-room were observed to be in working order. Center provides breakfast and lunch, menus were are posted at the center. Center has an updated fire drill log.

LPA reviewed the sign/in-sign/out sheet. LPA reviewed children's emergency card. All currently employed with the Center have criminal record clearances and health screening. All staff members present today has current Pediatric CPR and First Aid.
LPA advised the Director of the Notice of Site Visit posting requirement. LPA provided the Licensing Agency website (www.ccld.ca.gov), so the lead teacher and/or staff may obtain updated licensing information, regulations, and forms.

A current CPR/First Aid for at least one staff member observed, immunization records and documentation of the educational background, training, and/or experience. LPA also observed mandated training certificates in staff files.
No Title 22 deficiencies were observed in the areas that were evaluated today. A Notice of Site Visit was posted and must remain posted for a period of 30 days. An exit interview was conducted.

The Center is open July-May. Center hours 8:00 A.M.-3:00 P.M..
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Charlotte BaneyTELEPHONE: (916) 216-7791
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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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