394500354-1-12-2021-53-CC-ASIS-BX7NSQ-20210112094329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500354
Report Date: 01/04/2021
Date Signed: 01/12/2021 09:44:23 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:	CAMPUS II, INC, THE		FACILITY NUMBER:	394500354
ADMINISTRATOR:	MEGHAN GODDARD		FACILITY TYPE:	830
ADDRESS:	6311 PACIFIC AVE		TELEPHONE:	(209) 951-5437
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	20	CENSUS: 6	DATE:	01/04/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Tina Smith & Ervin Smith		TIME COMPLETED:	12:00 PM

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) Alecia Sifuentes met with Applicants, Tina Smith and Ervin Smith for the purpose of an announced pre-licensing change of ownership tele-inspection (due to COVID-19). Applicant requests an infant license to serve 20 infant children from birth to two years of age. The program will operate Monday through Friday from 6:00 AM to 6:00 PM. The fire clearance was granted and received on 12/28/20. Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat poster, menus, and daily schedule. AS discussed the forms that must be in each child's and each staff member's file. Applicant stated the Infant Needs and Services plans will be kept in the classrooms. The facility will be providing breakfast, lunch, and snacks. Parents will provide formula, breast milk, and baby food for their children. INDOOR ACTIVITY SPACE: There is one infant classroom. AS observed a sufficient amount of equipment, toys, tables, chairs, high chairs, cubbies, 9 napping cots, and 11 cribs. Applicant acknowledges there will be a maximum of 11 infants under 12 months old, due to available cribs. There is a first aid kit in each of the classrooms. Medications will be stored in the top cupboards. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated there will be a water pitcher and cups available in the classroom. AS observed a functional carbon monoxide detector in the office. AS observed an electronic sign-in/sign-out system. Report continues on 809-C.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2021

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: CAMPUS II, INC, THE	FACILITY NUMBER: 394500354
	VISIT DATE: 01/04/2021

NARRATIVE

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AS measured the classroom. The total classroom space contains a total of 844 square feet, which will accommodate Applicant's request for 20 infant children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). There are two sinks for the children, and a separate private restroom for the staff. AS observed a changing table within arm's reach of a sink. Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property for both infant and preschool children and there is a Shared Playground Waiver on file. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by a canopy.

AS measured the outdoor activity space. The outdoor play area contains a total of 2,318 square feet, which will accommodate Applicant's request for 20 infant children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

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: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2021

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: CAMPUS II, INC, THE	FACILITY NUMBER: 394500354
	VISIT DATE: 01/04/2021

NARRATIVE

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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 Applicant 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 Applicant. Applicant 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.

The following items are required before a license will be issued:
1. Proof of enrollment for EMSA Preventative Health & Safety for Director
2. TB test for Director
3. Influenza vaccine or letter declining the flu for Director
4. Final review of the file by Licensing Program Manager (LPM) Bettina Engelman

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2021

LIC809 (FAS) - (06/04)

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