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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317666
Report Date: 02/05/2025
Date Signed: 02/05/2025 11:49:34 AM

Document Has Been Signed on 02/05/2025 11:49 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:ROOSEVELT ELEMENTARY SCHOOLFACILITY NUMBER:
390317666
ADMINISTRATOR/
DIRECTOR:		IMELDA MAHARFACILITY TYPE:
850
ADDRESS:776 SOUTH BROADWAYTELEPHONE:
(209) 953-4670
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 23TOTAL ENROLLED CHILDREN: 17CENSUS: 13DATE:
02/05/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Keller, DebraTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On February 5th, 2025, at 9:45 AM, Licensing Program Analyst (LPA), David Nguyen met with facility representative, Debra Keller for the purpose of an Unannounced Annual Inspection as well as for the purpose of the Room Change Inspection. The purpose of the unannounced annual inspection and the Room Change inspection were explained. LPA was granted entrance into childcare facility by facility representative. Licensee had request for a Room Change for twenty-three (23) three-through-five-year-old children of the twenty-three (23) children the childcare facility is currently licensed for. This will be a change of classroom from Room D-1 to Room B-12. Community Care Licensing Division (CCLD) had received the granted fire clearance from Fire Prevention Division, City of Stockton on 1/30/2025 for the Room Change of Roosevelt Elementary School.

Facility days and hours of operation for the Head Start Preschool Classroom are Monday through Friday from 8:00 AM to 2:00 PM. The Roosevelt Elementary School operates between August and May every year. There were thirteen (13) children present in the Head Start Preschool class during today’s inspection. Meals—breakfast and lunch were provided to children in care and brought by Stockton Unified School District. Drinking water was provided to children in care. LPA verified license annual fees are current.

INDOOR ACTIVITY SPACE:
The indoor space is one classroom. LPA observed the facility has a total of two (2) toilets and three (3) sinks. This is sufficient to meet the needs of the requested twenty-three (23) children. The classroom is equipped with child-sized furnishings. Facility representative stated the program does offer a nap session. LPA observed nap cots to be utilized by children care. The classroom contains a total measurement of 1016.75. square feet which is enough to accommodate the licensed capacity request of twenty-three (23) Preschool Age children.

Report continues on LIC809-C...(Page 2)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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 3
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: ROOSEVELT ELEMENTARY SCHOOL
FACILITY NUMBER: 390317666
VISIT DATE: 02/05/2025
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(Page 2)
LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. Facility representative stated that childcare teachers used water cooler and disposable cups for drinking water during outdoor playtimes. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (cushioned turf) under the play structure. LPA reviewed the sign in/out book and observed that the children are properly signed in.

All staff present during today's inspection have a fingerprint clearance through the Stockton Unified School District. 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 reviewed children’s and staff files. LPA observed that health screening reports and proof of immunization are centrally stored in an off-site location. At least one staff member present during today's inspection has current Pediatric CPR and First Aid. LPA observed training certificate for approved third party mandated reporter training resource for all staff. 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 provider is currently providing Incidental Medical Services (IMS) services to children in care. IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. LPA observed one (1) care plan in the classroom. The care plan was kept in the backpack and placed in the cabinet above the classroom sink. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm


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

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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: ROOSEVELT ELEMENTARY SCHOOL
FACILITY NUMBER: 390317666
VISIT DATE: 02/05/2025
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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.

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.

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



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.

Effective today, 2/5/2025, LPA is granting a license.

Exit interview conducted and report was reviewed with facility representative, Debra Keller. Appeal rights and a notice of site visit were provided. A copy of this report will remain on file for a period of three years for public review upon request. Facility representative’s signature on this form acknowledges receipt of this form. A notice of site visit was posted and must remain posted for 30 days for parental review. 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: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC809 (FAS) - (06/04)
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