393604033-12-10-2021-53-CC-ESIA-C9KTYP-20211210140905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393604033
Report Date: 12/10/2021
Date Signed: 12/10/2021 02:09:43 PM

Document Has Been Signed on 12/10/2021 02:09 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:	COLONIAL HEIGHTS STATE PRESCHOOL		FACILITY NUMBER:	393604033
ADMINISTRATOR:	ARDELEAN, GRETCHEN		FACILITY TYPE:	850
ADDRESS:	8135 BALBOA AVENUE		TELEPHONE:	(209) 953-8734
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 15	CENSUS: 15	DATE:	12/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Rena Damele		TIME COMPLETED:	02:15 PM

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On 12/10/21 at 11:00 am Licensing Program Analyst (LPA) Elvira Sierra met with Facility Representative, Gretchen Ardelean for the purpose of an unannounced annual inspection. Facility operates inside the Colonial Heights campus in classroom # 6, M-F from 08:00 to 11:00 morning class and 12:00 to 03:00 afternoon class. Upon arrival present in the facility were 2 staff members and 1 child. Facility representative stated they are getting ready for the second session and morning children are leaving. LPA returned to the facility at 12:45 pm and met with Preschool Specialist, Rena Damele. Present in the facility were 3 staff and 15 children.

LPA conducted a health and safety inspection in all areas accessible to children and the following was observed; Per facility representative currently, no children required medication, but facility will keep the medication in the front office or in a lock cabinet in the classroom. There are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. LPA observed a functional smoke/carbon monoxide detector and a fully charged 2A:10BC fire extinguisher. The floors appeared clean throughout the facility. Outdoor play area is free from dangerous conditions. Program does not provide napping. Program provides breakfast, lunch and afternoon snacks that is prepared by the Child Nutrition department following the State guidelines. Menus were posted in the classroom. Facility offer drinking water by using water bottles and disposable cups.

At 01:20 pm 2 children and 3 staff record's were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification, which expires on 11/2022. All staff currently employed with the facility have a health screening report; LPA verified documentation of the educational background, training, and/or experience.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Report continues on subsequent page 809-C.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: COLONIAL HEIGHTS STATE PRESCHOOL	FACILITY NUMBER: 393604033
	VISIT DATE: 12/10/2021

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Incidental Medical Services (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. 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.

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/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Gretchen Ardelean.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021

LIC809 (FAS) - (06/04)

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