394500015-10-5-2023-53-CC-SWIS-CWBT2T-20231005142116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500015
Report Date: 10/05/2023
Date Signed: 10/05/2023 02:21:19 PM

Document Has Been Signed on 10/05/2023 02:21 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	CAPC - NORTH (PRESCHOOL)		FACILITY NUMBER:	394500015
ADMINISTRATOR:	MARISOL GARCIA		FACILITY TYPE:	850
ADDRESS:	2875 HOLLY DRIVE		TELEPHONE:	(209) 851-3479
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	24	CENSUS: 11	DATE:	10/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Naomi Johnson		TIME COMPLETED:	12:40 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	On October 5, 2023, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative, Naomi Johnson for an unannounced 1 Year Required inspection. LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Today’s census included 11 children being supervised by 2 staff members. The Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday, 8:30AM- 3:00 PM. The Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPA observed that all classrooms appeared clean including the carpets and floor. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. LPA observed a functional carbon monoxide detector. Chemicals and cleaning materials were kept inaccessible to children. The food preparation space is free of litter and all food was protected against contamination. Trash cans have tight fitting lids. Medications are stored in an area inaccessible to children. The Facility Representative stated there are no poisons, bodies of water, or weapons on the premises. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Shade was provided to children via trees and awning. Drinking water was readily available to children both indoors and outdoors. Menus were posted for breakfast,lunch,and afternoon snack. LPA observed required licensing postings were visible to parents. LPA observed a current children's roster and fire drill; the last drill was conducted on. During this inspection, LPA observed that the facility is equipped with First Aid equipment. Sign in sheets are done electronically. *Continued on LIC 809-C.....*

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CAPC - NORTH (PRESCHOOL)	FACILITY NUMBER: 394500015
	VISIT DATE: 10/05/2023

NARRATIVE

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During today’s inspection staff and children’s files were reviewed. LPA observed current immunization records, documentation of the educational background, training, and/or experience and Mandated Reporter training certificates in staff files. It was observed that at least one staff member present today has current Pediatric CPR and First Aid certification (expires: 7/2025). Each child's file contained appropriate documentation: emergency card, consent for emergency medical treatment and notifications of children’s and parent’s rights, health history, physician's report and immunization records.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

No citations were issued based on today’s inspection. Exit interview conducted and report was reviewed with the Facility Representative, Noami Johnson. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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