393622010-3-29-2021-53-CC-ESIA-BZKUU5-20210329155259

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393622010
Report Date: 03/29/2021
Date Signed: 03/29/2021 03:53:05 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:	CAPC - SBS IW (INF)		FACILITY NUMBER:	393622010
ADMINISTRATOR:	TURNER-HARDIN, LINDY		FACILITY TYPE:	830
ADDRESS:	540 N. CALIFORNIA STREET		TELEPHONE:	(209) 644-5311
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95202
CAPACITY:	9	CENSUS: 6	DATE:	03/29/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Kim		TIME COMPLETED:	01:45 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	NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via FaceTime was conducted.On Monday, March 29th, 2021, at 11:43 AM, Licensing Program Analyst (LPA) Elvira Sierra conducted a Case Management inspection and met with Director, Kim Pawlowicz for the purpose of increasing infant capacity and adding a toddler option to the existing License. Facility requested to increase capacity to 27 children (15 infants, 12 toddler);Facility has a current capacity of 9 infant children. Present in the facility was Director, 2 staff and 6 infant children. Facility is adding two classrooms to the existing infant license. This facility will operate in classrooms #106 (infant classroom) , # 148 (Infant classroom) and #143 (Toddler classroom). Hours of operation are M-F 7:00AM -05:30 PM year round. Facility is a combination center with a preschool License on site. Indoor Activity Space At 11:55 AM, with the help of the Director, a virtual health and safety inspection in all areas accessible to children was conducted. Director measured the classrooms and LPA walked her through the measuring process. Classroom space measures at 1208.215 square feet, allowing for 34 children which will accommodate the capacity requested of 27 children. There are a total of 2 toilets and 6 sinks in the classrooms. LPA observed one refrigerator to storage milk on the infant classrooms. There are sufficient napping equipment and cribs for the children capacity. There is a diaper changing station within an arm’s reach of a sink. LPA observed cubbies inside the classrooms for children’s belongings. Toys and play equipment are age appropriate. Isolation area will be in the main office with the use of the staff restroom if needed. LPA reminded Director that the isolation area must have crib, cot or mat for each ill infant. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Outdoor Active Space Outdoor space was previously measure on inspection dated 2/28/2008 and per Director no changes have been made to the yard. Outdoor space measured 10,987 square feet (528 square feet was deducted for the storage shed and electrical boxes). This will accommodate the requested capacity. Director stated that a water jug and cups are made available to children when they go outside to play. The Director showed LPA a shade structure that is used to provide additional shade. The outdoor play yard will be used by both licenses; preschool and infants/toddlers. Director stated that the classrooms are scheduled to use the playground at separate times and a waiver of schedule rotation is in place and filed with the Department. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. Report continues on subsequent page 809C---

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

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: CAPC - SBS IW (INF)	FACILITY NUMBER: 393622010
	VISIT DATE: 03/29/2021

NARRATIVE

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Director was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation, and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

A Fire Clearance was granted on 03/19/21 for the request capacity.
Capacity for 27 infant/toddler children is granted effective today 03/29/21. An updated license will be mailed from the regional office.

An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the tele-inspection This facility evaluation report was reviewed and discussed with Director and a copy of this report (LIC 809) and a notice of site visit was email to Director. Director understands she must read the report and send back an acknowledgement that she read and received the report. Notice of Site Visit (LIC 9213) should be posted and remain posted for 30 days. . Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature. Please note: When a physical inspections takes place, requests for alterations may be made.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

LIC809 (FAS) - (06/04)

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