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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390319950
Report Date: 12/21/2023
Date Signed: 12/21/2023 12:39:13 PM

Document Has Been Signed on 12/21/2023 12:39 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MONTEZUMA SCHOOLFACILITY NUMBER:
390319950
ADMINISTRATOR:FLORES, GABRIELAFACILITY TYPE:
850
ADDRESS:2843 FARMINGTONTELEPHONE:
(209) 933-7255
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 48TOTAL ENROLLED CHILDREN: 36CENSUS: 28DATE:
12/21/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Gabriela FloresTIME COMPLETED:
01:00 PM
NARRATIVE
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On December 21st, 2023, at 9:25 AM, Licensing Program Analyst (LPA), David Nguyen met with Facility Representative, Gabriela Flores to conduct an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. LPA was granted for entry into the facility by the Facility Representative.

The Head Start program in the portable is Monday through Friday, from 8:00 am to 2:00 pm and serves breakfast and lunch to children. The AM State Preschool program located in room 4 is Monday through Friday, from 7:45 am to 10:45 am, and serves breakfast to children. The PM State Preschool program located in room 4 is Monday through Friday, from 11:15 am to 2:15 pm, and serves lunch to children. All meals—breakfast and lunch—are provided by the Stockton Unified School District. The Montezuma School operates from August to May every year. LPA reminded the Facility Representative that Montezuma School has an annual fees balance. LPA provided the Facility Representative the PIN number and annual fee balance.

LPA toured the inside and outside of the facility, including all activity/classroom areas, restrooms, and outdoor play areas. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (wood chips) under the play structure.

LPA observed two toilets and two sinks for use by the children in the Head Start portable. LPA observed a separate staff bathroom which was inaccessible to the children. Cleaning supplies were stored in an upper locked cabinet. LPA observed children's toys were in good condition and in sufficient supply. LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed functioning carbon monoxide and smoke alarms. LPA observed that all the required forms were posted including a license, meal/snack menu that meets regulation, parents' rights' poster, emergency care and disaster plan and seat belt law. Report continues on LIC809-C....(Page 2)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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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