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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393614184
Report Date: 01/23/2025
Date Signed: 01/23/2025 11:42:55 AM

Document Has Been Signed on 01/23/2025 11:42 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:FILLMORE ELEMENTARYFACILITY NUMBER:
393614184
ADMINISTRATOR/
DIRECTOR:		TIARA BLAKEFACILITY TYPE:
850
ADDRESS:2644 E. POPLAR STREETTELEPHONE:
(209) 933-7185
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 24TOTAL ENROLLED CHILDREN: 21CENSUS: 21DATE:
01/23/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Ramirez, SoniaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On January 23rd, 2025, at 9:30 AM, Licensing Program Analyst (LPA), David Nguyen met with facility representative, Sonia Ramirez for the purpose of an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. LPA was granted entrance into childcare facility by facility representative. Facility days and hours of operation are Monday through Friday from 8:00 AM to 11:00 AM for AM session and from 12:00 PM - 3:00 PM for PM session. There were twenty-one (21) children present in the AM class during today's inspection. Meals—breakfast and lunch were provided to children in care. Fillmore Elementary opens between August and May every year. Drinking water was provided to children in care. Childcare children brought their water bottles for drinking water.

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 children brought their own water bottles during indoor and 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.

LPA reviewed children’s and staff files. All staff present during today's inspection have a fingerprint clearance. 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.

Report continues on LIC809-C...(Page 2)

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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: FILLMORE ELEMENTARY
FACILITY NUMBER: 393614184
VISIT DATE: 01/23/2025
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(Page 2)
LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. 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.

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/.



LPA discussed the Year-Round/Daily Reminder of Water Safety Requirements and Measures with facility representative. LPA provided facility representative the PIN 23-17-CCLD, the Year-Round and Daily Reminder of Water Safety Requirements and Measures. LPA stressed the importance of checking the premises for bodies of water daily prior to children’s arrival with facility representative.

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.

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.



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

Report continues on LIC8089-C...(Page 3)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
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: FILLMORE ELEMENTARY
FACILITY NUMBER: 393614184
VISIT DATE: 01/23/2025
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(Page 3)
Exit interview conducted and report was reviewed with facility representative, Sonia Ramirez. 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: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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