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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317570
Report Date: 10/01/2024
Date Signed: 10/01/2024 11:56:52 AM

Document Has Been Signed on 10/01/2024 11:56 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AUGUST ELEMENTARY SCHOOLFACILITY NUMBER:
390317570
ADMINISTRATOR/
DIRECTOR:		GONZALES, RENEEFACILITY TYPE:
850
ADDRESS:2101 SUTROTELEPHONE:
(209) 953-4258
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 23TOTAL ENROLLED CHILDREN: 25CENSUS: 9DATE:
10/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Anna GupusanTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On October 1st, 2024, at 9:45 AM, Licensing Program Analysts (LPAs), David Nguyen and Deborah Khashe met with facility representative/lead teacher, Anna Gapusan for the purpose of an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. LPAs were granted entrance by facility representative. Facility days and hours of operation are Monday through Friday from 7:45 AM to 10:45 AM for AM session and from 11:15 AM - 2:15 PM for PM session. There were nine (9) children present during today's inspection. Meals—breakfast and lunch were provided to children in care. The August Elementary School opens between August and May every year. Water from drinking fountain was provided for drinking water. LPA Nguyen discussed license annual fees with facility representative and verified license annual fees are up to date.

Both LPA Nguyen and LPA Khashe toured the facility inside and out. LPAs observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPAs reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. Facility representative stated that childcare teachers brought water cooler with disposable cups to outdoor during outdoor play time. LPAs observed all required forms to be posted. LPAs observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. LPA Khashe reviewed the sign in/out sheets on the binder and observed that the children are properly signed in.

Report continues on LIC-809...(Page 2)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: AUGUST ELEMENTARY SCHOOL
FACILITY NUMBER: 390317570
VISIT DATE: 10/01/2024
NARRATIVE
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(Page 2)
Outdoor activity space surface is maintained in a safe condition and is free of hazards. A new play equipment was installed in the playground that is used by the State classrooms. LPAs inspected playground equipment and safety labels from the manufacturer. Manufacturer sticker states equipment to be used for two-through-twelve-year-old children. Playground equipment was observed to be in good repair and areas around high climbing equipment, swings and slides have cushioning material to absorb falls. Facility representative stated that the preschoolers share the playground and play structure with the school-aged children at different times.

LPA Khashe reviewed children’s and staff files. All staff present during today's inspection have a fingerprint clearance. Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. LPA observed AB1207 Mandated Reporter training certificates for all staff. Facility representative was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.


Report continues on LIC809-C...(Page 3)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: AUGUST ELEMENTARY SCHOOL
FACILITY NUMBER: 390317570
VISIT DATE: 10/01/2024
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(Page 3)
For IMS information see PIN 22-02-CCP. The following information regarding ADA and Incidental Medical Services (IMS) policy were discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the Year-Round/Daily Reminder of Water Safety Requirements and Measures with facility representative. LPA provided facility representative the PIN 23-17-CCLD, the Year-Round and Daily Reminder of Water Safety Requirements and Measures. LPA stressed the importance of checking the premises for bodies of water daily prior to children’s arrival to improve children’s safety with facility representative.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.



For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Report continues on LIC-809-C...(Page 4)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: AUGUST ELEMENTARY SCHOOL
FACILITY NUMBER: 390317570
VISIT DATE: 10/01/2024
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(Page 4)
Facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation and regulation information.

Exit interview conducted and report was reviewed with facility representative/lead teacher, Anna Gapusan. Appeal Rights and Notice of Site Visit were provided. Facility representative’s signature on this form acknowledged the receipt of the form. Notice of Site Visit was posted and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during the inspection.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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