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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500030
Report Date: 07/12/2019
Date Signed: 07/12/2019 11:48:57 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 - GREAT VALLEY 53FACILITY NUMBER:
394500030
ADMINISTRATOR:BROWN, LAPRICEFACILITY TYPE:
850
ADDRESS:4223 MCDOUGALD BLVDTELEPHONE:
(209) 851-3479
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:24CENSUS: 0DATE:
07/12/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Liz RogersTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Mary Ponce and Chayntel Hunter met with Director of Business Operations Liz Rogers and Program Manager Andrea Collier for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 24 preschool children from two to five years of age. The program will operate Monday through Friday providing two half day programs. The fist program will be from 8:00AM- 11:00AM and the afternoon program will be 12:30 PM to 3:30 PM.

LPAs provided LIC311A. Applicant acknowledge that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat law, menus, and daily schedule. LPAs discussed the forms that must be in each child's and each staff member's file. Liz stated the program will utilize an IPAD for electronic sign in and sign out sheet system and Applicant understand the facility must be able to produce at least one month's sign in and sign out sheets for LPA upon request. The program will be providing a morning snack for the first preschool session and afternoon snacks for the afternoon session.

INDOOR ACTIVITY SPACE:
The classrooms is located on the West Side of the Campus in classroom 53 titled Great Valley 53. the classroom includes dramatic play area, manipulative, reading area, art area, and science area. LPAs observed 20 chairs and 4 tables meant for children. Due to the fact that the preschool is broken up in to two half day programs, the preschoolers will not be napping at the facility; therefore, napping equipment are not needed. There will be a refrigerator in the classroom for perishable foods. Liz stated that all snacks are provided by

Report continued on LIC 809-C
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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 - GREAT VALLEY 53
FACILITY NUMBER: 394500030
VISIT DATE: 07/12/2019
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Creative Childcare Inc. There is a first aid kit that will be kept in on top of the refrigerator when installed. Medications will also be stored on top of the fridge. LPAs observed cleaning disinfectants stored on the top shelf of the cabinet in the classroom. Applicant stated there are no poisons on the premises. LPAs observed 24 cubbies which will accommodate the capacity requested. Liz stated that the facility will have water delivered to the program for children to access and will provide proof to LPA prior to licensor. LPA observed a pitcher and cups for water when children are outside. LPAs observed a 2A10BC fire extinguisher in the classroom that was serviced July 16th, 2018. Liz will have the fire extinguisher serviced prior to licensor. LPAs observed a working Carbon Monoxide detector in the facility.

LPAs measured all classroom space. The classrooms contains a total of 897.00552 square feet, which will accommodate the applicant's request for 24 preschool children. The facility will be utilize shared toilets with the other licensed facility at the elementary school. Liz provided a waiver for shared bathroom space. There are are 3 toilet stalls and 3 sinks in the bathroom and a separate private restroom for the staff. The facility will maintain visual observation by escorting children to the bathrooms and maintaining at least one staff member in the bathroom while in children are present. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the staff lounge which is located in classroom 54.

OUTDOOR ACTIVITY SPACE:
There is one main outdoor area on the property. The outdoor play area is fenced with a chain link fence. The fence is at least four feet tall. There is a sandbox that needs a cover prior to licensor. The outdoor space has a bark area with a climbing structure that is age appropriate. There are no firearms or bodies of water on the premises. There are shaded areas supplied by trees, large umbrellas and overhangs.


Report continued on LIC 809-C
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 - GREAT VALLEY 53
FACILITY NUMBER: 394500030
VISIT DATE: 07/12/2019
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The outdoor activity space was measured. The outdoor play area contains a total of 8,894.2977 square feet, which will accommodate the applicant's request for 24 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Liz stated she will use a water pitcher and cups that will be accessible to children. The garden area and the shed will be off limits to children in care. LPA advised Liz that if the facility would like to utilize the garden, they must replace the wooden garden bench prior to an LPA inspecting to deem the area safe for children to utilize.

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. Liz stated the facility will use the companies "Care Plan" which will be submitted prior to licensor.

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

LPAs discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; criminal record clearances; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPAs provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Applicant can request to be added to the distribution list to receive Quarterly Updates.

This facility evaluation report was reviewed and discussed with the Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for

Report continued on LIC 809-C

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 - GREAT VALLEY 53
FACILITY NUMBER: 394500030
VISIT DATE: 07/12/2019
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information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

During inspection, LPA collected pertinent documentation for the application.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:


1. A final review of the file by LPM Maria Mayorga.
2. Proof of at least 4 more chairs for children in care.
3. Proof of water dispenser for indoors drinking water.
4. Proof of purchased sandbox cover.
5. Submission of "Care Plan" (IMS)
6. Proof of installation of fridge.
7. Proof of installed door chimes.
8. Proof of recently serviced fire extinguisher.
9. Completion of an outdoor Facility sketch including off limit garden area.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4