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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621067
Report Date: 12/13/2021
Date Signed: 12/13/2021 01:23:31 PM

Document Has Been Signed on 12/13/2021 01:23 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:CAP KERN EARLY HEAD START PROG - CHRISMANFACILITY NUMBER:
393621067
ADMINISTRATOR:GLORIA MONTEZFACILITY TYPE:
830
ADDRESS:23950 S CHRISMAN ROADTELEPHONE:
(209) 242-9540
CITY:TRACYSTATE: CAZIP CODE:
95304
CAPACITY: 32TOTAL ENROLLED CHILDREN: 13CENSUS: 12DATE:
12/13/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Patricia MexicanoTIME COMPLETED:
02:00 PM
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Application Specialist (AS) Alecia Sifuentes met with Site Supervisor, Patricia Mexicano for the purpose of an announced change of capacity inspection. Licensee requests to lower the toddler option to serve 16 toddlers from 18 to 36 months. The program operates Monday through Friday from 7:30 a.m. to 5:30 p.m. The granted fire clearance was received on 12/8/2021.

INDOOR ACTIVITY SPACE:
AS observed two toddler classrooms and one infant classroom. Site Supervisor stated that they are closing classroom four. Classroom one is utilized by the infants and classrooms two and three is utilized by the toddlers. The total toddler classroom space contains a total of 626 square feet, which will accommodate Licensee's request for 16 toddlers. There are two toilets and two sinks for the children, and a separate private restroom for the staff. AS used previous measurements recorded on the 2016 Capacity Worksheet (LIC 9024).

OUTDOOR ACTIVITY SPACE:
There are three outdoor areas on the property. The is one infant outdoor area and two toddler outdoor area. The outdoor play areas are fenced with a chain link fence that is at least four feet tall. AS observed a sufficient amount of equipment and toys. There are no bodies of water on the premises.

AS observed the toddler outdoor activity space. The outdoor play area contains a total of 1,624 square feet, which will accommodate Licensee's request for 16 toddlers. AS used previous measurements recorded on the 2018 Capacity Worksheet (LIC 9024).

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2021
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: CAP KERN EARLY HEAD START PROG - CHRISMAN
FACILITY NUMBER: 393621067
VISIT DATE: 12/13/2021
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Incidental Medical Services and a Plan of Operation is located in the facility file. 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.

This facility evaluation report was reviewed and discussed with the Licensee. Licensee was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

Effective today, 12/13/2021, AS will approve the facility for a capacity of 24 children 8 infants and 16 toddlers under the toddler option program.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC809 (FAS) - (06/04)
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