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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500554
Report Date: 03/18/2022
Date Signed: 03/18/2022 02:10:48 PM


Document Has Been Signed on 03/18/2022 02:10 PM - It Cannot Be Edited

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:TOVAR GARCIA, MARIAFACILITY NUMBER:
394500554
ADMINISTRATOR:TOVAR GARCIA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 986-8824
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:14CENSUS: 0DATE:
03/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Maria Tovar GarciaTIME COMPLETED:
02:15 PM
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At 12:45pm on 1/11/2022 Licensing Program Analyst (LPAs) Aruna Sridharan and Marivel Hernandez met with licensee for an announced case management inspection. Licensee is requesting change of location as she is moving from previous licensed address 5925 Dresden Way, Stockton CA 95212 (License #393610678) to current home at 11490 N Alpine Road, Stockton CA 95212.
The hours of operation are Monday-Friday from 6:00am to 6:00pm. All adults are fingerprint cleared.
LPA toured the home inside and out. The licensee owns the home which is a two storey home with five bedrooms and three bathrooms. The home has living, dinning, kitchen and half bathroom. OFF LIMIT areas include: two bedrooms, master bath/bedroom on the first floor and entire upstairs. Licensee acknowledges that children may never enter these off-limit areas.
The front of the house has cherry orchard of 5 acreage and the front yard is unfenced. The side yard is fenced and is set up for outdoor play area. The backyard has a pool. The sideyard does not have access to the pool by having 6 feet iron fence. The licensee understands that 100% supervision is needed when children are in an unfenced area. Licensee understands that prior to making alterations or additions to the home or grounds the licensee shall notify licensing agency per regulation 102416.3
Home has working fire extinguisher, carbon monoxide and smoke detectors that meet regulations. The fire extinguisher and first aid kit is next to TV in the family room inaccessible to children. The LPAs facetime with LPM Jeanne Smith regarding the pool meeting regulations. The pool has access from sliding door from the entryway which does not have self latching gate and does not meet Title 22 regulations. Licensee stated there are no firearms. Cleaning compounds are stored in upper cabinet in the kitchen. Sharp utensils like knives and medications are stored in the upper cabinet in the kitchen. The home contains appropriate toys for the children.
The Licensee provided proof of enrolment for Lead Poisoning Prevention module on 1/22/2022. Licensee has CPR and First Aid (exp:01/2023) and has proof of enrollment for Mandated Reporter.
Licensee is following COVID guidelines and precautions to provide care for children at this time.
The case management for change of location will be approved for license when the Licensing Program Manager will do a facility visit along with LPA to review if pool meets Title 22 regulations. The licensee needs to submit Lead Poisoning Prevention module.
The facility is pending license.
Notice of Site Visit was posted.
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2022
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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