<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317664
Report Date: 03/29/2023
Date Signed: 03/29/2023 02:55:15 PM

Document Has Been Signed on 03/29/2023 02:55 PM - It Cannot Be Edited

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:PULLIAM SCHOOLFACILITY NUMBER:
390317664
ADMINISTRATOR:COLE, KAYFACILITY TYPE:
850
ADDRESS:230 PRESIDIO WAYTELEPHONE:
(209) 951-2459
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 22TOTAL ENROLLED CHILDREN: 16CENSUS: 14DATE:
03/29/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Breanna FredrickTIME COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/29/23 Licensing Program Analyst (LPA), Elvira Sierra conducted an unannounced case management inspection and met with Facility representative, Breanna Fredricksen. Present were three staff supervising 14 children. Program is in compliance with Staff/Child ratios.

During the inspection, facility representative and LPA discussed unusual incident occurred on 03/24/23 in which Child #1 wandered outside the classroom due to the classroom door being left opened by Janitorial staff. The child walked himself to the campus office. Facility representative stated that yard duty teacher escorted child back to the classroom a few minute later after noticing child was missing from the classroom. Facility representative stated that was child first day in the program and that there were three staff supervising 11 children at the time of the incident. Facility representative stated that the campus gates leading to the street remained always locked so children are not able to leave the campus grounds. Also the classroom is always locked and only accessible to school employees. Facility representative stated a Staff meeting was held on 03/25/23 to discuss plans for supervision in the classroom and to make sure all staff know and understand that there must be 100% supervision 100% of the time. Child #1 continues to attend program. LPA observed adequate levels of supervision on today's inspection.

See attached 809D for deficiency cited. Exit interview conducted and this report and Appeal of Rights were reviewed and provided to facility representative, Breanna Fredrick. Notice of Site Visit posted and should remain posted for 30 days. FOR TYPE A DEFICIENCIES ONLY, upon receipt, facility representative shall post this report with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt. (LIC 9224 was provided).

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/29/2023 02:55 PM - It Cannot Be Edited


Created By: Elvira Sierra On 03/29/2023 at 02:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: PULLIAM SCHOOL
FACILITY NUMBER: 390317664

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/30/2023
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229 (a)(1) Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision.....(1) No child(ren) shall be left without the supervision of a teacher at any time..... This requirement was not met as evidence by;
1
2
3
4
5
6
7
Facility representative stated that program held a staff meeting regarding proper supervision. Facility representative also stated that she talked to the campus principal regarding janitorial staff not leaving the classroom door open when children are present. Facility representative provided LPA with an agenda of the training attendance held on 03/24/23 on today's inspection.
8
9
10
11
12
13
14
Facility representative admitted they were unaware that the child had wandered away from the classroom. This is a violation that if not corrected poses an immediate risk to the children in care.
8
9
10
11
12
13
14
Deficiency is cleared on today's visit. Civil Penalty of five hunded follars($500.00) will be assess on the next page.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Bettina Engelman
LICENSING EVALUATOR NAME:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2