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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615405
Report Date: 10/01/2019
Date Signed: 10/01/2019 01:42:50 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:FRED T KOREMATSU CDCFACILITY NUMBER:
573615405
ADMINISTRATOR:CARRIE WILKESFACILITY TYPE:
840
ADDRESS:3100 LOYOLA DR.TELEPHONE:
(530) 753-9223
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY:70CENSUS: 17DATE:
10/01/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Site Supervisor, Kristie BrantleyTIME COMPLETED:
02:10 PM
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Licensing Program Analysts (LPAs) Christopher Jackson and Chayntel Hunter met with Site Supervisor, Kristie Brantley on 10/01/19 for the purpose of an unnanounced random annual inspection. This facility is located on Fred T Korematsu Elementary School grounds. The facility operates Monday - Friday from 7:00 A.M. to 6:00 P.M. The facility provides breakfast, lunch and afternoon snack for the children. Census at time of inspection was 17 school-aged chidren supervised by 3 staff.

LPAs toured the facility including all activity/classroom areas, the isolation area, food service area, restrooms and outdoor play areas. LPAs reviewed care and supervision of children, staffing ratios, health related services, furniture, equipment, drinking water and food service provisions. The facility uses the elementary school playground, as well as Mace Ranch Park located across the grass field to the west of the center.

LPAs reviewed the children's Identification and Emergency Information. LPAs reviewed personnel's education and immunization requirements. All staff currently employed with the center have criminal record clearances and are associated to the Sunset Ranch site facility #313620604. At least one staff member present today has current EMSA approved Pediatric/Child CPR and First Aid. All staff members present have current AB1207 mandated reporter training certificates. This facility provides Incidental Medical Services- IMS. LPAs reviewed storage of medication, and observed required medical authorization forms.

LPAs provided the Community Care Licensing’s website www.ccld.ca.gov, so the Site Supervisor can obtain updated licensing information, new regulations and access forms. LPAs reviewed report with the Site Supervisor and an exit interview was conducted. Notice of Site Visit was provided and it must remain posted for 30 days for parental review.

No Title 22 Deficiencies observed in the areas that were evaluated.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019
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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