393605420-2-26-2025-53-CC-ESIA-DE9SAF-20250226124217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393605420
Report Date: 02/26/2025
Date Signed: 02/26/2025 12:42:23 PM

Document Has Been Signed on 02/26/2025 12:42 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:	CREEKSIDE STATE PRESCHOOL		FACILITY NUMBER:	393605420
ADMINISTRATOR/ DIRECTOR:	NGUYEN,NHUNG		FACILITY TYPE:	850
ADDRESS:	2515 ESTATE DRIVE, PORTABLE B		TELEPHONE:	(209) 331-7252
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 35	CENSUS: 31	DATE:	02/26/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Nhung Nguyen		TIME VISIT/ INSPECTION COMPLETED:	01:00 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 02/26/25, Licensing Program Analyst (LPA) Elvira Sierra met with Facility Representative, Nhung Nguyen for the purpose of an unannounced annual inspection. LIC 125(Entrance Checklist for Child Care Centers) was provided to facility representative. The facility operates in portables #29 and # 43 inside the Creekside Elementary School campus. The program conducts part-time session 8-11 a.m. in Room 29 (state preschool classroom) and full-day session (8 am to 2 pm) in portable # 43 (Head Start classroom). Facility follows Lodi Unified School District calendar year. Present in the facility were 15 children and 3 staff in portable/classroom #29 and 2 staff supervising 16 children in classroom/portable #43. Facility is in compliance with staff/children ratio on today's inspection. LPA conducted a health and safety inspection in all areas accessible to children and the following was observed; Appropriate care,and supervision was observed. Facility was clean and all toilets, and hand washing areas are in safe and sanitary operating condition. Furniture and equipment are in good repair. Staff stated that there are no children at this time that required medication. First Aid Kit and Emergency supplies are available and stored inaccessible to children. No bodies of water were observed in the premises and per representative there are no weapons in the facility. Disinfectant and cleaning supplies are inaccessible to children and store in an lock upper cabinet in the classrooms. Functioning telephone, carbon/smoke detectors were observed in the classrooms. A 2A10BC fire extinguisher was observed in each classroom. All posting requirements were observed including meal menus for the children. Outdoor play area is maintained in a safe condition and was observed free of any hazards. Playground equipment is in good condition and cushioning material was observed to absorb falls. Facility provides breakfast/lunch for the Head Start program and lunch for the State program, no snacks are provided. Meals are prepared and served at the school cafeteria. Per facility representative uncontaminated drinking water is readily available both indoor and outdoor by water fountains. Sing in/out sheets were reviewed. Facility fire drills are conducted monthly in conjunction with the elementary school and is properly log. Facility has approved waivers on file for commingling with children with disabilities who attend the Lodi Unified Special Education Preschool Program during the schedule outdoor learning times. Also facility has an approved outdoor space waiver to shared kindergarten play area with another program. Staff understands that waiver conditions must be follow when using the kindergarten play area. Report continues on subsequent page 809C--

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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: CREEKSIDE STATE PRESCHOOL	FACILITY NUMBER: 393605420
	VISIT DATE: 02/26/2025

NARRATIVE

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Five children's and 5 staff's files were reviewed and contain appropriate documentation required by Licensing. At least one staff trained in CPR and Pediatric First Aid was observed to be present.

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.

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/.

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 childcare 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.
Testing Expiration Date: 10/24/2028.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Report continues on subsequent page 809C--

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC809 (FAS) - (06/04)

Page: 2 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: CREEKSIDE STATE PRESCHOOL	FACILITY NUMBER: 393605420
	VISIT DATE: 02/26/2025

NARRATIVE

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LPA received copies of updated facility documents (LIC 500-personal Report, LIC 610-Emergency Disaster Plan, Water inspection and Sampling Report, LIC 308). LIC 309- Administrative Organization along with an updated LIC200A with currently hours of operation will be mail to Licensing Office. LPA advised that granted waiver letters must be posted next to facility License for parental review.
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.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Nhung Nguyen.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC809 (FAS) - (06/04)

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