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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615405
Report Date: 07/01/2020
Date Signed: 07/01/2020 03:45:54 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:YVONNE APILADOFACILITY TYPE:
840
ADDRESS:3100 LOYOLA DR.TELEPHONE:
(530) 753-9223
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY:70CENSUS: 15DATE:
07/01/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Site Supervisor, Yvonne ApiladoTIME COMPLETED:
03:45 PM
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Due to COVID19 pandemic, Licensing Program Analyst (LPA) Chayntel Hunter is conducting a tele-inspection via FaceTime with Site Supervisor, Yvonne Apilado. In lieu of Site Supervisor's signature, LPA Hunter is e-mailing the report with a read receipt request.

LPA Hunter met with Site Supervisor, Yvonne Apilado to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 06/25/2020. During today's visit the facility was toured. Present were 15 school age children in care and 3 staff.

LPA interviewed the Site Supervisor who was present during the incident. LPA reviewed and discussed this report with the Site Supervisor.

The facility reported the UIR to Community Care Licensing within 24hrs. A written UIR was submitted within 7 days, describing the specifics of the incident.

Site Supervisor stated she will speak to all teaching staff reminding them of the importance of doing face to name head counts every 20-30 minutes. The total number of children in attendance will be relayed to all staff insuring the children are within sight and sound. The Staff-Child Ratio Sheet will also be updated during the head counts to ensure children's safety.

This facility evaluation report was reviewed and discussed with Site Supervisor. Exit interview was conducted. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020
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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