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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570310386
Report Date: 11/07/2019
Date Signed: 11/07/2019 11:35:51 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:CESAR CHAVEZ SCHOOL AGE CDCFACILITY NUMBER:
570310386
ADMINISTRATOR:MONROE, MARY ALLISONFACILITY TYPE:
840
ADDRESS:1221 ANDERSON ROADTELEPHONE:
(530) 753-3808
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:124CENSUS: 0DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Assistant Site Supervisor- Latika JainTIME COMPLETED:
11:40 AM
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Licensing Program Analysts (LPAs) Amy Silva and Chayntel Hunter met with Assistant Site Supervisor Latika Jain for the purpose of an unannounced random annual inspection. Upon arrival, there were no children present. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPAs toured the classroom, restrooms, and outdoor play areas. Assistant Site Supervisor stated there are no poisons on the premises. Medications, toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. All food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides breakfast, lunch and afternoon snacks. Menus were posted. Drinking water was readily available to children both indoors and outdoors. LPAs observed full legal signatures while reviewing the sign in and sign out sheets.

Three staff and three children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 1/27/2020). Mandated reporter training is current for all staff.

All staff currently employed with the facility have a criminal record clearance, health screening report, mandated reporter training certificates, immunization records, and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises. LPAs observed a functional carbon monoxide detector and fire extinguisher. Facility conducts monthly disaster drills and documents them.

Report continues on 809-C.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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: CESAR CHAVEZ SCHOOL AGE CDC
FACILITY NUMBER: 570310386
VISIT DATE: 11/07/2019
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Facility is providing Incidental Medical Services. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for 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.

LPAs provided and discussed Effects of Lead Exposure brochure.

An exit interview was conducted with Assistant Site Supervisor and in the areas that were evaluated, no deficiencies were observed at the time of the inspection. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy SilvaTELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2