390317664-8-14-2023-53-CC-ESIA-CUPP5K-20230814110054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 390317664
Report Date: 08/14/2023
Date Signed: 08/14/2023 11:00:58 AM

Document Has Been Signed on 08/14/2023 11:00 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:	PULLIAM SCHOOL		FACILITY NUMBER:	390317664
ADMINISTRATOR:	KRYSTAL TAYLOR		FACILITY TYPE:	850
ADDRESS:	230 PRESIDIO WAY		TELEPHONE:	(209) 951-2459
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY: 22	TOTAL ENROLLED CHILDREN: 11	CENSUS: 9	DATE:	08/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cynthia Hammond		TIME COMPLETED:	11:00 AM

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On 08/14/23, Licensing Program Analyst (LPA) Elvira Sierra met with Facility Representative, Cynthia Hammond for the purpose of an unannounced annual inspection. Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Census included nine children supervised by two staff. The program operates in room # 16 inside the Pulliam Elementary School Campus. Facility hour of operation are Monday through Friday 07:30am-11:00am and 11:45am to 03:15pm.

LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor area. Age appropriate toy and reading material were observed. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. Facility provide meal that are prepared at the facility. Facility has a fire extinguisher that meets the minimum requirements, operating smoke and a carbon monoxide detectors. Menus were posted and drinking water was readily available to children both indoors and outdoors. Emergency supplies are available and maintained. First Aid Kit is properly maintained and kept inaccessible to children. Classrooms have appropriate postings. Emergency Drills are conducted monthly and are properly logged.

Two staff and five children's records were reviewed and are complete containing required licensing forms. At least one staff member present today has current Pediatric CPR and First Aid certification.

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.

Report continues on subsequent page 809C--

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

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: PULLIAM SCHOOL	FACILITY NUMBER: 390317664
	VISIT DATE: 08/14/2023

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Incidental Medical Services (IMS) policy was 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

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 may 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 CARE tools, please send email inquiries 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.

Exit interview conducted and report was reviewed with the facility representative, Cynthia Hammond. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

LIC809 (FAS) - (06/04)

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