393621112-11-8-2023-53-CC-DNGN-CXDRAP-20231108115130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393621112
Report Date: 11/08/2023
Date Signed: 11/08/2023 11:51:41 AM

Document Has Been Signed on 11/08/2023 11:51 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	GLEASON PARK - SUSD HEAD START		FACILITY NUMBER:	393621112
ADMINISTRATOR:	NATALIE LOPEZ		FACILITY TYPE:	850
ADDRESS:	605 E. CHURCH STREET		TELEPHONE:	(209) 466-4995
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95203
CAPACITY:	20	CENSUS: 12	DATE:	11/08/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Nathalie Lopez		TIME COMPLETED:	12:00 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	On November 8^th, 2023, at 10:20 AM, Licensing Program Analyst (LPA) David Nguyen and Licensing Program Manager (LPM) Chayntel Hunter met with Site Supervisor, Nathalie Lopez, for the purpose of an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. Both LPA and LPM were granted entrance by the site supervisor. Facility days and hours of operation are Monday through Friday with two classes. The first class (AM Session) attends from 8:00 AM to 11:30 AM and the second (PM Session) class attends from 12:00 PM to 3:30 PM. Facility provides breakfast to the first (AM) class and lunch to the second (PM) class. The food is prepared and supplied by the school district. There were twelve (12) children present during today's inspection. The Gleason Park—SUSD Head Start runs on a 10-month program from August to the end of May every year. LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (rubber turf) under the play structure. LPA reviewed the sign in/out book and observed that the children are properly signed in. Report continues on 809-C...(Page 2)

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David Nguyen	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GLEASON PARK - SUSD HEAD START	FACILITY NUMBER: 393621112
	VISIT DATE: 11/08/2023

NARRATIVE

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LPA reviewed children’s and staff files. All staff present during today's inspection have a fingerprint clearance. LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. LPA observed AB1207 Mandated Reporter training certificates for all staff. The Site Supervisor was reminded to renew the course every 2 years through www.mandatedreporterca.com website. Site Supervisor 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.

This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medications 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. When any IMS is provided, an updated Plan of Operation that includes 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 discussed the Year-Round/Daily Reminder of Water Safety Requirements and Measures with site supervisor. LPA provided site supervisor the PIN 23-17-CCLD, the Year-Round and Daily Reminder of Water Safety Requirements and Measures.

Report continues LIC-809-C...(Page 3)

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David Nguyen	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GLEASON PARK - SUSD HEAD START	FACILITY NUMBER: 393621112
	VISIT DATE: 11/08/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the Site Supervisor. A notice of site visit was provided and must remain posted for 30 days. The site supervisor's signature on this form acknowledges receipt of this form. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during the inspection.

SUPERVISOR'S NAME: Chayntel Hunter	TELEPHONE: (916) 917-8620
LICENSING EVALUATOR NAME: David Nguyen	TELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC809 (FAS) - (06/04)

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