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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621291
Report Date: 11/16/2023
Date Signed: 11/16/2023 11:53:23 AM


Document Has Been Signed on 11/16/2023 11:53 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:VAN BUREN ELEMENTARY SCHOOLFACILITY NUMBER:
393621291
ADMINISTRATOR:RINGEN, IONEFACILITY TYPE:
850
ADDRESS:1628 E. TENTH STREETTELEPHONE:
(209) 933-7305
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:24CENSUS: 11DATE:
11/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Lead Teacher Jennifer CraigTIME COMPLETED:
12:15 PM
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On 11/16/23, Licensing Program Analyst Carla Polanco Rivera (LPA), met with Lead Teacher Jennifer Craig, in room #17. Today's visit was for the purpose of an unannounced annual inspection. During today's inspection there were 11 children present at start of inspection. LPA inspected classroom inside and out. Facility days and hours of operation are Monday- Friday, 8:00 AM-2:00 PM.

LPA reviewed care and supervision of children, staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. There are adequate toys and equipment available for children. Outdoor play areas were toured and appeared to be in good repair, there is sufficient cushioning under the play structures. Toileting facilities were in operating, safe, and sanitary condition. LPA observed all required forms to be posted. Menus were posted and drinking water was readily available to children.
Meals are provided by the district and served to the children in the classroom.

LPA reviewed the sign in/out clip boards in classrooms and observed that children are properly signed in.


Staff and children's records were reviewed. Children's files contained an emergency card and consent for medical treatment. At least one staff member present has current Pediatric CPR and First Aid certification, (Exp. 06/2024 ).

Report Continued on LIC809-C.............

SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Carla Polanco RiveraTELEPHONE: (916) 212-0752
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
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: VAN BUREN ELEMENTARY SCHOOL
FACILITY NUMBER: 393621291
VISIT DATE: 11/16/2023
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All staff present are currently employed through the District and have a criminal record clearance, mandated reporter certificates, and documentation of the educational background, training, and/or experience. LPA observed health screening reports with TB test and required MMR and TDAP vaccines for staff members. Staff are required to renew Mandated Reporter training every 2 years, training is available through the www.mandatedreporterca.com website.

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 Jennifer Craig. A notice of site visit was posted by LPA 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: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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