394500015-1-3-2020-53-CC-CJAN-BKGQW3-20200103113116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500015
Report Date: 01/03/2020
Date Signed: 01/03/2020 11:31:24 AM

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 - NORTH (PS)		FACILITY NUMBER:	394500015
ADMINISTRATOR:	ROGERS, LIZ		FACILITY TYPE:	850
ADDRESS:	2875 HOLLY DRIVE		TELEPHONE:	(209) 851-3479
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	24	CENSUS: 0	DATE:	01/03/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kim Ballard		TIME COMPLETED:	11:45 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	Licensing Program Analysts (LPAs) Christopher Jackson and Stacey Williams met with Applicant CAPC representative Early Education Director Kim Ballard and Program Manager Cherryl Balatbat for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 24 preschool children from age two to entry into kindergarten. The program will operate Monday through Friday from 7:45 AM to 1:45 PM. The fire clearance was granted on 12/18/19. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat poster, menus, and daily schedule. LPAs discussed the forms that must be in each child's and each staff member's file. LPAs provided and discussed LIC311A, Effects of Lead Exposure brochure, Healthy Schools Act survey, and new immunization card. The facility will provide breakfast, lunch, and afternoon snacks. LPAs observed a kitchen area for food preparation. Early Education Director Kim Ballard stated the meals will be brought into the facility by CCCI. INDOOR ACTIVITY SPACE: There is one preschool classroom: P2 that sits on the campus of North Elementary School. LPAs observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in each of the classrooms. Medications will be stored in the office in a locked box. LPAs observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPAs observed water fountain in the classrooms. LPAs observed a functional carbon monoxide detector in the classroom. LPAs observed an electronic sign-in/sign-out system. Report continues on 809-C.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

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: CAPC - NORTH (PS)	FACILITY NUMBER: 394500015
	VISIT DATE: 01/03/2020

NARRATIVE

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LPAs measured the one classroom. The total classroom space contains a total of 1011.714 square feet, which will accommodate Applicant's request for 24 preschool children. There are two toilets and two sinks for the children, and a separate private restroom for the staff. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall and separates the preschool yard from the North Elementary Campus. LPAs observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees. The play area will be shared with the Tracy Unified School District First Five program adjacent to the portable building being used by CAPC. CAPC has submitted a waiver request for shared for the shared playground space.

LPA measured the outdoor activity space. The outdoor play area contains a total of 5947.975 square feet, which will accommodate Applicant's request for 24 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the facility file. Incidental Medical Services and a Plan of Operation is located in the facility 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.

Report continues on 809-C.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 - NORTH (PS)	FACILITY NUMBER: 394500015
	VISIT DATE: 01/03/2020

NARRATIVE

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LPAs discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPAs discussed with Applicant 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 Applicant. Applicant 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.

Based on approval from LPM, Maria Mayorga, as of 01/03/2020, the facility is licensed with a capacity of 24 preschool Children. An exit interview was conducted, and a Notice of Site Visit was posted.

SUPERVISOR'S NAME: Sharon Ogbodo	TELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher Jackson	TELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3