394500254-8-13-2020-53-CC-SDLA-BSFSDD-20200813134658

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500254
Report Date: 08/13/2020
Date Signed: 08/13/2020 01:47:11 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 STEIN		FACILITY NUMBER:	394500254
ADMINISTRATOR:	MARTINEZ, ESTEFANI		FACILITY TYPE:	830
ADDRESS:	650 W 10TH STREET		TELEPHONE:	(209) 851-3479
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	14	CENSUS: 0	DATE:	08/13/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Cherryl Balatbat		TIME COMPLETED:	10:45 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	Application Specialist (AS) Seychelle De Luca and Licensing Program Analyst (LPA) Stacey Williams met with Program Manager Cherryl Balatbat for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Program Manager request an infant license to serve eight infants from birth to two years old and six toddlers from 18-36 months under a Toddler Option. The facility will operate Monday through Friday 7:30 AM to 5:30 PM. The fire clearance was granted on 7/16/2020. Prior to today, Licensee Representative requested a waiver for all employee clearances to be associated to CAPC - Central 1 #393610932. AS granted the waiver and Program Manager understands the waiver must be posted at all times and the conditions of the waiver must be met. The facility is located at Stein High School. Program Manager acknowledges 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. AS discussed the forms that must be in each child's and each staff member's file. The facility will provide all snacks and meals. INDOOR ACTIVITY SPACE: There is one classroom that is divided into an infant area and Toddler Option area. The half wall separating the infant area and Toddler Option area is three feet tall, which does not meet the requirement of four feet. AS and LPA observed a sufficient amount of tables, chairs, cribs, napping cots, cubbies, toys, and equipment for the requested capacity. There are four cribs available and Program Manager acknowledges the facility may have a maximum of four infants under 12 months old. The first aid kit, medications, and cleaning disinfectants are in inaccessible areas of the classroom. Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2020

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 STEIN	FACILITY NUMBER: 394500254
	VISIT DATE: 08/13/2020

NARRATIVE

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Program Manager stated there are no poisons or firearms on the premises. Program Manager stated they will have a water cooler delivered and children will bring sippy cups. AS observed a functional carbon monoxide detector in the classroom. Program Manager stated the program will use an electronic sign-in/sign-out system.

Program Manager measured the classroom; and AS walked her through the measuring process. The total classroom space contains a total of 664.5003 square feet, which accommodates the request for 14 children. AS and LPA observed a changing pad that is within arm's reach of a sink. The changing pad is at least one inch thick with raised sides that are at least three inches tall. The napping area is located next to the infant area and is separated from the activity area. The half wall is three feet and nine inches, which does not meet the requirement of four feet. There are two toilets and three 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 a specified area in the classroom 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 fences and walls that are at least four feet tall. AS and LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There is shade supplied by a permanent shade structure and trees.

Program Manager measured the outdoor space; and AS walked her through the measuring process. The outdoor play area contains a total of 4024.04 square feet, which accommodates the request for 14 children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the Administrative 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.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2020

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 STEIN	FACILITY NUMBER: 394500254
	VISIT DATE: 08/13/2020

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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.

AS discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Program Manager and Director 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 Program Manager. Program Manager 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.

This facility evaluation report was reviewed and discussed with Director. AS emailed a copy of the 809 to Program Manager. Program Manager understands she must open the email to send back an acknowledgement of receipt. AS provided LIC311A, Effects of Lead Exposure brochure, safe sleep brochures, and immunization card.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. Verification the half wall separating the activity space from the crib area is four feet tall.
2. Verification the half wall separating the infant activity space and Toddler Option activity space is four feet tall.
3. Waiver request for infants and toddlers to share the outdoor space.
4. Submission of remaining licensing documents (LIC 308, LIC 500, LIC 610, and sketches, Director's packet, list of furniture and equipment, and lease).
5. A final review of the file by Licensing Program Manager Maria Mayorga.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2020

LIC809 (FAS) - (06/04)

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