394500013-9-9-2021-53-CC-ESIA-C6PT4N-20210909142413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500013
Report Date: 09/09/2021
Date Signed: 09/09/2021 02:24:19 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 - LATHROP		FACILITY NUMBER:	394500013
ADMINISTRATOR:	BALLARD, KIM		FACILITY TYPE:	850
ADDRESS:	721 THOMSEN RD		TELEPHONE:	(209) 490-2618
CITY:	LATHROP	STATE: CA	ZIP CODE:	95330
CAPACITY:	48	CENSUS: 12	DATE:	09/09/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Cherryl Balatbat		TIME COMPLETED:	02:40 PM

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Licensing Program Analysts (LPAs) Elvira Sierra and Stacey Williams met with Program Administrator, Cherryl Balatbat for the purpose of an unannounced annual/random inspection. Facility operates M-F 08:00 am to 02:30 pm. Upon arrival, LPAs observed 12 children supervised by 4 staff members.

LPAs conducted a health and safety inspection in all areas accessible to children and the following was observed; Per facility representative currently, one child in care required medication. A copy of Incidental Medial Service was provided to LPAs. Staff stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. LPAs observed a functional smoke/carbon monoxide detector and a fully charged 2A :10BC fire extinguisher. The floors appeared clean throughout the facility. Outdoor play area is free from dangerous conditions and playground equipment is securely anchored to the ground. Facility uses rubber floor under the play equipment to absorb falls. Program provides breakfast, lunch and afternoon snacks. Menus were posted by the main entrance of the facility. Facility offer drinking water by using water dispenser and disposable cups. Sign in/out sheet were reviewed.

10 children files were reviewed. Each child's file contained an emergency card, and a medical assessment. Files for the staff present at the facility were reviewed. Staff have a criminal record clearance, health screening report, immunization records, Mandated Reporter Training and documentation of the educational background, training, and/or experience. LPAs reviewed the Department's inspection authority and discussed with staff any changes that may occur regarding Director/Site Supervisor or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on 809-C.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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 - LATHROP	FACILITY NUMBER: 394500013
	VISIT DATE: 09/09/2021

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Facility representative 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.

Exit interview conducted and report was reviewed with the facility representative, Cherryl Balatbat.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira Sierra	TELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

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