393621291-10-14-2020-53-CC-FDIZ-BUDUAW-20201014152524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393621291
Report Date: 10/14/2020
Date Signed: 10/14/2020 03:26:12 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:	VAN BUREN ELEMENTARY SCHOOL		FACILITY NUMBER:	393621291
ADMINISTRATOR:	RINGEN, IONE		FACILITY TYPE:	850
ADDRESS:	1628 E. TENTH STREET		TELEPHONE:	(209) 933-7305
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95206
CAPACITY:	24	CENSUS: 0	DATE:	10/14/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Debra Keller		TIME COMPLETED:	02:15 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 10/14/2020 Licensing Program Analyst (LPA) Fabiola Diaz and Application Specialist (AS) Seychelle De Luca met with Director Debra Keller for the purpose of an announced room change tele-inspection (due to COVID-19) in lieu of an on-site visit. Director requests for the preschool license that serves 24 children ages 3 to 5, to move from classroom #16 to classroom #17. The program will operate Monday through Friday from 8:00 AM to 3:30 PM. LPA received the school's fire clearance on 7/24/20 . LPA and AS observed and discussed the following postings: license, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. The facility will provide food from the campus cafeteria. INDOOR ACTIVITY SPACE: AS and LPA observed a sufficient amount of equipment, tables, and chairs. There is a first aid kit by the main entrance of the classroom. Medications will be stored appropriately in a cabinet. Cleaning disinfectants are appropriately stored and inaccessible to children. Director stated there are no poisons in the facility. Director stated there are no firearms on the premises. AS and LPA observed a water fountain in the classroom. Director stated a water jug and cups will be used during COVID-19. AS and LPA observed a functional carbon monoxide detector. Director stated that a paper sign-in/sign-out system will take place at the school entrance. There are two functioning toilets and two sinks for children in care. Children who become ill during the day will be isolated in the entrance of the classroom within the cubby area and will use the staff bathroom, if necessary. There is an additional sink within the activity area. LPA and AS observed the Director measure the indoor space, which contains 900 usable square feet and can accommodate 24 children.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

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: VAN BUREN ELEMENTARY SCHOOL	FACILITY NUMBER: 393621291
	VISIT DATE: 10/14/2020

NARRATIVE

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OUTDOOR ACTIVITY SPACE:
AS and LPA observed the outdoor play area to be fenced with sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by overhangs. Director stated that when the school is open additional shade is added with tarps. LPA and AS observed the Director measure the outdoor space, which contains 7,315 usable square feet and can accommodate 24 children at one time. A waiver for a shared play outdoor space can be found in file.

Incidental Medical Services and a Plan of Operation is located in the administrative file. Incidental Medical Services (IMS) policy was discussed. 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 following: supervision; personal rights; inspection authority; criminal record clearances, reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Director any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility evaluation report was reviewed and discussed with Director. Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

The Room Change to classroom #17 has been approved as of 10/14/2020. LPA emailed a copy of the LIC 809 and a Notice of Site Visit to Director. Director understands she must read the report and send LPA an email stating she received, read, and understands today’s report. LPA also provided Director with Effects of Lead Exposure brochure.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola Diaz	TELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

LIC809 (FAS) - (06/04)

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