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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616423
Report Date: 08/28/2024
Date Signed: 08/28/2024 12:08:37 PM

Document Has Been Signed on 08/28/2024 12:08 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HENRY ELEMENTARYFACILITY NUMBER:
393616423
ADMINISTRATOR/
DIRECTOR:		GIRLIE HALEFACILITY TYPE:
850
ADDRESS:1107 S. WAGNERTELEPHONE:
(209) 933-7490
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 22DATE:
08/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Peggy BryantTIME VISIT/
INSPECTION COMPLETED:
12:12 PM
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On August 28, 2024, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative, Peggy Bryant for the purpose of an unannounced annual inspection. Program operation hours are Monday through Friday (Morning class- 8:15AM -11:15AM and Afternoon class 12:00PM-3:00PM). Upon arrival, LPA observed twenty-two (22) children supervised by three staff. Criminal record clearances are conducted through Stockton Unified School District.

LPA conducted a health and safety inspection for all areas accessible to children. Representative stated 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 and playground equipment is securely anchored to the ground. Facility has an shared outdoor space waiver on file. Program provides breakfast and lunch. Meals are provided through the school district. Menus were posted in the entry of the facility. Facility utilizes drinking water from the sink faucet (indoors) and water fountain (outside play structure).

Sign in/out sheets were reviewed. Each child has a designated sign in/out sheet. Fire drills are conduced to meet regulatory standards. Facility Representative stated that fire drills are conducted monthly with the elementary school.

Child files were reviewed. Each child’s file included information pertaining to their authorized representative, consent for medical treatment, immunization records, and a medical assessment form. Files for staff who were present at the facility were reviewed. Staff have a criminal record clearance through Stockton Unified school district. Mandated Reporter training completion certificates are from Keenan and Associates. Health screening report, immunization records, and documentation of their educational background, training, and/or experience is located in the Human Resources office within the school district. Document in staff files states verification of staff meeting regulatory requirements. CPR/ First Aid certification was verified for staff present. Lead Teacher’s CPR/First Aid certification expiration date is 8/2025.

LPA reviewed the Department's inspection authority and discussed with staff any changes that may occur regarding Director/Site Supervisor or an employee acting in the director's absence must be reported to department within 10 working days.

Continued on LIC 809-C.....

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HENRY ELEMENTARY
FACILITY NUMBER: 393616423
VISIT DATE: 08/28/2024
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The 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.

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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 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.

No citations were issued based on today’s inspection. Exit interview conducted and report was reviewed with the Facility Representative, Peggy Bryant. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights were provided.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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