394500257-8-20-2020-53-CC-SDLA-BSNSZP-20200820141929

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500257
Report Date: 08/20/2020
Date Signed: 08/20/2020 02:19:46 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:	RIVERBROOK		FACILITY NUMBER:	394500257
ADMINISTRATOR:	BURNS, DENISE		FACILITY TYPE:	850
ADDRESS:	4811 RIVERBROOK DR		TELEPHONE:	(209) 953-8731
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95219
CAPACITY:	24	CENSUS: 0	DATE:	08/20/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Rena Damele		TIME COMPLETED:	11:15 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 met with Preschool Specialist Rena Damele for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Preschool Specialist requests a preschool license to serve 24 preschool children from age three years to entry into kindergarten. The program will operate Monday through Friday from 8:00 AM to 11:00 AM and 12:00 PM to 3:00 PM. The fire clearance was granted on 7/24/2020. Preschool Specialist acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. The facility will be providing morning and afternoon snacks. INDOOR ACTIVITY SPACE: There is one preschool classroom (Room 14). AS observed a sufficient amount of equipment, toys, tables, chairs, and cubbies. There is a first aid kit in the classroom. Medications will be stored in each of the classroom in a locked cabinet. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Preschool Specialist stated there are no poisons or firearms on the premises. AS observed water fountain in each of the classrooms. AS observed a functional carbon monoxide detector in the classroom. Preschool Specialist stated the facility will use a paper sign-in/sign-out system. 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: 08/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020

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: RIVERBROOK	FACILITY NUMBER: 394500257
	VISIT DATE: 08/20/2020

NARRATIVE

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Preschool Specialist measured the classroom; and AS walked her through the measuring process. The total classroom space contains a total of 776.3683 square feet, which will not accommodate the request for 24 preschool children. There are two toilets and two sinks for the children that are located across the hall from the classroom and the preschool has exclusive use. There is 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 quiet area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property and the preschool has exclusive use. The outdoor play area is fenced with a chain link fence that is at least four feet tall. Preschool Specialist stated the climbing structure is anchored in and the safety label reads it is intended for children ages two to five years old. Preschool Specialist stated the equipment and toys will arrive next week. There are no bodies of water on the premises. There are shaded areas supplied by trees and a canopy over the climbing structure.

Preschool Specialist measured the outdoor space; and AS walked her through the measuring process. The outdoor play area contains a total of 2446.5 square feet, which will accommodate the 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 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.

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: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020

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: RIVERBROOK	FACILITY NUMBER: 394500257
	VISIT DATE: 08/20/2020

NARRATIVE

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AS 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. AS discussed with Preschool Specialist 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.

Preschool Specialist 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 Preschool Specialist. Preschool Specialist understands she must open the email to send back an acknowledgement of receipt. AS provided LIC311A, Effects of Lead Exposure brochure, and immunization card.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:
1. A final review of the file by Licensing Program Manager Sharon Ogbodo.
2. Submit Personnel Report (LIC 500) with signature on second page.
3. Submit updated Personnel Policies and Admission Agreement for the Administrative File.
4. Submit Director's enrollment in EMSA certified Preventative Health and Safety course or EMSA certified stand alone lead prevention training.
5. Mail in an updated Application (LIC 200A) with section 2 and section 10 (22 preschool children) filled out correctly and signed only by Licensee Representative Jennifer Hayes.
6. Updated fire clearance for 22 children.
7. Proof the teacher area in the classroom has been moved.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020

LIC809 (FAS) - (06/04)

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