394500375-3-22-2021-53-CC-ASIS-BZCSN8-20210322140106

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500375
Report Date: 03/22/2021
Date Signed: 03/22/2021 02:02:17 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 - MAIN		FACILITY NUMBER:	394500375
ADMINISTRATOR:	NORIEGA, BLANCA		FACILITY TYPE:	850
ADDRESS:	800 E MAIN ST		TELEPHONE:	(209) 851-3479
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95202
CAPACITY:	34	CENSUS: 0	DATE:	03/22/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kim Pawlowicz & Blanca Noriega		TIME COMPLETED:	02:30 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 Director of Early Education, Kim Pawlowicz and Program Manager, Blanca Noriega for the purpose of an announced pre-licensing tele-inspection via FaceTime in lieu of an on-site visit due to COVID-19. Director requests a preschool license to serve 34 preschool children from age three to five years old. The program will operate Monday through Friday from 7:00 a.m. to 5:30 p.m. The fire clearance was granted and received on 3/15/2021. Director 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. The facility will provide breakfast, lunch, and afternoon snack. INDOOR ACTIVITY SPACE: There are two preschool classrooms. AS observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid pack in each classroom. First aid wall box's will also be installed in each of the classrooms. Medications will be stored in a medication lock box inside a locked cabinet. Director stated cleaning disinfectants will be appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Director stated there will be water pitchers and cups available for children through out the day. AS observed a functional carbon monoxide detector in both classrooms. Director stated they will be using 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: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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: CAPC - MAIN	FACILITY NUMBER: 394500375
	VISIT DATE: 03/22/2021

NARRATIVE

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AS measured two classrooms. The total classroom space contains a total of 1,385 square feet, which will accommodate Director's request for 34 preschool children. There are 4 toilets and 4 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 teacher's work space area 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 a wrought iron fence that is at least four feet tall. AS observed a sufficient amount of equipment and toys. The play structure is designated for the use of children 2 to 5 years old. There are no bodies of water on the premises. There are shaded areas supplied by overhangs and a canopy.

AS measured the outdoor activity space. The outdoor play area contains a total of 2,550 square feet, which will accommodate Director's request for 34 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's 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: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

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: CAPC - MAIN	FACILITY NUMBER: 394500375
	VISIT DATE: 03/22/2021

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 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 discussed and emailed to the Director. 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.

The following items are required before a license will be issued:
1. Final file review by 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: 03/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2021

LIC809 (FAS) - (06/04)

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