394500284-9-25-2020-53-CC-SDLA-BTSQFN-20200925120812

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500284
Report Date: 09/25/2020
Date Signed: 09/25/2020 12:08:23 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:	ANNUCIATION EXTENDED CARE		FACILITY NUMBER:	394500284
ADMINISTRATOR:	RODRIGUEZ, SHANNON		FACILITY TYPE:	840
ADDRESS:	425 WEST MAGNOLIA ST		TELEPHONE:	(209) 465-2961
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95203
CAPACITY:	75	CENSUS: 0	DATE:	09/25/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Shannon Rodriguez		TIME COMPLETED:	09:30 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 Specialists Seychelle De Luca and Alecia Sifuentes met with Licensee Representative Shannon Rodriguez for the purpose of an announced prelicensing tele-inspection (due to COVID-19). Licensee Representative requests a school-age license to serve 75 school-age children enrolled in kindergarten and above. The program will operate Monday through Friday from 7:30 AM to 8:00 AM and 2:50 PM to 5:30 PM. AS De Luca received the school's fire clearance on 9/23/2020. Licensee Representative 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 and LPA discussed the forms that must be in each child's and each staff member's file. The facility will provide afternoon snacks and children will bring their own lunches (on early dismissal days). INDOOR ACTIVITY SPACE: Licensee Representative requests to use two spaces: Gym and Small Meeting Room. Application Specialists observed a sufficient amount of equipment, tables, and chairs. There is a first aid kit in the Small Meeting Room and Gym. Medications will be stored in the office. Application Specialists observed cleaning disinfectants are appropriately stored and inaccessible to children. Licensee Representative stated the poisons are located in a locked cabinet. Licensee Representative stated there are no firearms on the premises. Application Specialists observed a water cooler. Children will bring water bottles and the facility will have extra cups. Application Specialists observed a functional carbon monoxide detector. Application Specialists observed 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: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

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: ANNUCIATION EXTENDED CARE	FACILITY NUMBER: 394500284
	VISIT DATE: 09/25/2020

NARRATIVE

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Prior to today’s tele-inspection, Licensee Representative sent AS De Luca a signed letter from Principal. The letter states that the activity spaces are of sufficient size to accommodate Licensee Representative’s requested capacity of 75 school-age children. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement and toilet requirements; therefore, Application Specialists did not take measurements. There are two restrooms, one for boys and one for girls. There is a separate staff restroom. Children who become ill during the day will be isolated in the office and will use the staff bathroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property for school-age children and it is shared with the preschool children. Licensee Representative requested a shared outdoor space waiver prior to today's tele-inspection. Licensee Representative stated the climbing structure is anchored in. Licensee Representative was unable to locate the safety label, but she stated she knows it is intended for school-age children. Licensee Representative stated preschool children will not use the climbing structure. Licensee Representative stated Application Specialists observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.

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

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: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

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: ANNUCIATION EXTENDED CARE	FACILITY NUMBER: 394500284
	VISIT DATE: 09/25/2020

NARRATIVE

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Application Specialists discussed the following: supervision; personal rights; inspection authority; criminal record clearances, reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS and LPA discussed with Licensee Representative 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 Licensee Representative. Licensee Representative 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.

AS De Luca emailed a copy of the 809 to Licensee Representative. Licensee Representative understands she must read the report and send AS an email stating she received, read, and understands today’s report. AS also provided LIC311A and Effects of Lead Exposure brochure.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:

1. Submit proof of trash can with lid.

2. A final review of the file by Licensing Program Manager Sharon Ogbodo.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020

LIC809 (FAS) - (06/04)

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