394500270-8-25-2020-53-CC-SDLA-BSTQFF-20200825120753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500270
Report Date: 08/25/2020
Date Signed: 08/25/2020 12:08:03 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:	BANTA CDC		FACILITY NUMBER:	394500270
ADMINISTRATOR:	DELFINO, JODI		FACILITY TYPE:	850
ADDRESS:	22345 EL RANCHO RD		TELEPHONE:	(408) 966-6152
CITY:	TRACY	STATE: CA	ZIP CODE:	95304
CAPACITY:	48	CENSUS: 0	DATE:	08/25/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Jodi Delfino		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 and Licensing Program Analyst (LPA) Christopher Jackson met with Program Director Jodi Delfino for the purpose of an announced change of ownership prelicensing tele-inspection (due to COVID-19). Program Director requests a preschool license to serve 48 preschool children from age two to entry into kindergarten. The facility will operate Monday through Friday under from 6:30 AM to 6:30 PM. The fire clearance was granted on 8/17/2020. Licensee Representative will request a waiver for all employee clearances to be associated to Melville Jacobson CDC #393604765. The facility is located at Banta Elementary School. Program Director 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 breakfast, lunch, and afternoon snacks. INDOOR ACTIVITY SPACE: There are two preschool classrooms: Room 1 and Room 2. The kitchen is in between the two classrooms. AS and LPA observed a sufficient amount of equipment, toys, tables, chairs, napping cots, and cubbies. There is a first aid kit and medications and cleaning disinfectants will be in an area that is inaccessible to the children. Program Director stated there are no poisons or firearms on the premises. Program Director stated they will have a water jug and cups. AS observed a functional carbon monoxide detector in each of the classrooms. Program Director stated the program 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: 08/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020

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: BANTA CDC	FACILITY NUMBER: 394500270
	VISIT DATE: 08/25/2020

NARRATIVE

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Program Director measured the classrooms. The total classroom space contains a total of 1770.142 square feet, which will accommodate Program Director's request for 48 preschool children. There are four toilets and four 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 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. AS and LPA observed a sufficient amount of equipment and toys. There is no climbing structure. There are no bodies of water on the premises. There is shade supplied by a shade structure.

Program Director measured the outdoor activity space. The outdoor play area contains a total of 7652.085 square feet, which will accommodate Program Director's request for 48 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: 08/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020

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: BANTA CDC	FACILITY NUMBER: 394500270
	VISIT DATE: 08/25/2020

NARRATIVE

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AS 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. AS discussed with Program 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 Director. Program Director 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 Program Director. AS emailed a copy of the 809 to Program Director. Program Director understands she must open the email to send back an acknowledgement of receipt. AS provided LIC311A, Effects of Lead Exposure brochure, and new immunization card.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING THE LICENSE:
1. A final review of the file by Licensing Program Manager Sharon Ogbodo.
2. Program Director will submit a central fingerprint waiver request.
3. Submit the completed Preventative Health and Safety (with lead training) certificate.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020

LIC809 (FAS) - (06/04)

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