393622010-1-10-2024-53-CC-ASIS-CZCRXV-20240110122522

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393622010
Report Date: 01/10/2024
Date Signed: 01/10/2024 12:25:35 PM

Document Has Been Signed on 01/10/2024 12:25 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:	CAPC - SBS IW		FACILITY NUMBER:	393622010
ADMINISTRATOR:	SYHACHACK, MOME		FACILITY TYPE:	830
ADDRESS:	540 NORTH CALIFORNIA STREET		TELEPHONE:	(209) 644-5311
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95202
CAPACITY:	27	CENSUS: 21	DATE:	01/10/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kim Ballard		TIME COMPLETED:	11:00 AM

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	Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Director of Early Education, Kim Ballard for the purpose of a case management inspection. Licensee is requesting to increase the toddler component to 24 toddlers and keeping the infant capacity of 15 infants. The fire clearance (STD850) was granted and received on 1/9/2024. The program currently operates Monday through Friday from 7:30 a.m. to 5:30 p.m. INDOOR ACTIVITY SPACE: There are two infant classrooms located in Rooms 22 and 30 and there are two toddler classrooms located in Rooms 23 and 24, all upstairs. LPA observed a sufficient amount of equipment, toys, tables, chairs, cubbies, six cribs, and napping cots. LPA measured the infant and toddler classrooms. The infant classrooms contain a total of 860 square feet and the toddler classrooms contain a total of 1,077 square feet, which will accommodate Licensee’s request for 15 infants and 24 toddlers. There is 1 toilet and 8 sinks for the children. Licensee understands that one potty chair to every five infants/toddlers under 24 months being toilet trained will be needed if necessary. There is a separate restroom for staff located towards the front entrance, down the hall, lobby area, and one upstairs. OUTDOOR ACTIVITY SPACE: There is one outdoor activity space. LPA observed a Shared Outdoor Space Waiver on file from 2017, however the waiver did not include toddlers. LPA will provide Licensee with an updated waiver to post. Director stated that there has been no changes of the outdoor activity space since licensure. LPA used current outdoor measurements from report dated 3/29/2021, therefore LPA did not take measurements. The outdoor activity space contains a total of 10,987 square feet, which will accommodate Licensee’s request for 15 infants and 24 toddlers. Report continues on LIC809-C.

SUPERVISOR'S NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: 916-917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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: CAPC - SBS IW	FACILITY NUMBER: 393622010
	VISIT DATE: 01/10/2024

NARRATIVE

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Director 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director of Early Education, Kim Ballard.

Effective today, 1/10/2024, LPA will approve the change of capacity for 15 infants and 24 toddlers.

SUPERVISOR'S NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: 916-917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC809 (FAS) - (06/04)

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