394500399-10-22-2021-53-CC-ASIS-C82PPF-20211022112927

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500399
Report Date: 10/22/2021
Date Signed: 10/22/2021 11:29:38 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:	GYMSTARS ELITE LEARNING ACADEMY		FACILITY NUMBER:	394500399
ADMINISTRATOR:	RHONDA CONTE		FACILITY TYPE:	850
ADDRESS:	1740 W HAMMER LN		TELEPHONE:	(209) 955-7595
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	105	CENSUS: 0	DATE:	10/22/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jennifer Johnson and Bob Tanan		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, Bob Tanon and Jennifer Johnson for the purpose of an announced pre-licensing inspection. Applicant requests a preschool license to serve 105 preschool children from age two to entry into first grade. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance was granted and received on 9/7/2021. 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.. The facility will provide not be provided meals. INDOOR ACTIVITY SPACE: There are three preschool classrooms. AS observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in each of the classrooms. Medications will be stored in the teacher's cabinet. AS observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. AS observed water fountains and water filling station. AS observed a functional carbon monoxide detector in each classroom. 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: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: GYMSTARS ELITE LEARNING ACADEMY	FACILITY NUMBER: 394500399
	VISIT DATE: 10/22/2021

NARRATIVE

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AS measured three classrooms. The total classroom space contains a total of 4,189 square feet, which will accommodate Applicant's request for 105 preschool children. There are 8 toilets and 8 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 near the restrooms and kitchen.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a chain link 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 an overhang.

AS measured the outdoor activity space. The outdoor play area contains a total of 1515.0692 square feet, which will only accommodate 20 preschool children. Applicant has requested an Insufficient Outdoor Space Waiver and has provided outdoor schedules to accommodate the capacity requested. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: GYMSTARS ELITE LEARNING ACADEMY	FACILITY NUMBER: 394500399
	VISIT DATE: 10/22/2021

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 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.

Effective today, 10/22/2021, AS will approve the facility for a capacity of 105 preschool children licensed to serve 2 years to entry into first grade.

SUPERVISOR'S NAME: Jeanne Smith	TELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia Sifuentes	TELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

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