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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621113
Report Date: 08/15/2023
Date Signed: 08/15/2023 02:10:53 PM


Document Has Been Signed on 08/15/2023 02:10 PM - 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:COMMUNITY OF ALL NATIONS - SUSD HEAD STARTFACILITY NUMBER:
393621113
ADMINISTRATOR:KELLER, DEBRAFACILITY TYPE:
850
ADDRESS:2172 DOCKERY COURTTELEPHONE:
(209) 323-4351
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:20CENSUS: 4DATE:
08/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Lead Teacher Meagan ClavejoTIME COMPLETED:
02:30 PM
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On 8/15/23, Licensing Program Analyst Carla Polanco Rivera (LPA), met with Lead Teacher Meagan Clavejo, for the purpose of an unannounced Annual inspection. During today's inspection there were 4 children being supervised by two qualified staff. LPA toured the facility inside and out. Facility days and hours of operation are Monday- Friday 8:00 AM-2:00 PM. Program runs from August to May.

LPA reviewed care and supervision of children, staffing ratios and first aid supplies, furniture, equipment, fire drills and drinking water. There are adequate toys and equipment available for children. Outdoor play area was toured, the play area for the children appeared to be in good repair. Toileting facilities were in operating, safe, and sanitary condition. LPA observed all required forms to be posted. Food is provided by Edison High-school and children eat meals in the classroom. Drinking water was readily available to children. LPA reviewed the sign in/out book and observed that the children are properly signed in.

Staff and children's records were reviewed. Each child's file contained an emergency card and consent for medical treatment. At least one staff member present today has current Pediatric CPR and First Aid certification (Exp. 08/2023). All staff currently employed with the facility have a criminal record clearance, mandated reporter certificates, and documentation of the educational background, training, and/or experience.

Report continues on LIC809-C.....

SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Carla Polanco RiveraTELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: COMMUNITY OF ALL NATIONS - SUSD HEAD START
FACILITY NUMBER: 393621113
VISIT DATE: 08/15/2023
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LPA observed health screening reports with TB test and required MMR and TDAP vaccines for staff members. Staff was reminded to renew Mandated Reporter training every 2 years through the www.mandatedreporterca.com website.

Incidental Medical Services (IMS) policy was discussed. LPA reviewed storage of medication, and child personnel 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

Exit interview conducted and report was reviewed with Lead Teacher, Meagan Clavejo. A notice of site visit was provided and must remain posted for 30 days. 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: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Carla Polanco RiveraTELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC809 (FAS) - (06/04)
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