393621652-10-4-2024-53-CC-DNGN-D9QUEV-20241004153145

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393621652
Report Date: 10/04/2024
Date Signed: 10/04/2024 03:31:49 PM

Document Has Been Signed on 10/04/2024 03:31 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:	COUNTRY CLUB EARLY CARE & LEARNING CENTER		FACILITY NUMBER:	393621652
ADMINISTRATOR/ DIRECTOR:	VERONICA GONZALEZ		FACILITY TYPE:	850
ADDRESS:	2448 COUNTRY CLUB BOULEVARD		TELEPHONE:	(209) 941-9100
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95204
CAPACITY: 72	TOTAL ENROLLED CHILDREN: 41	CENSUS: 26	DATE:	10/04/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Gonzalez, Veronica		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

NARRATIVE

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On October 4^th, 2024, at 11:30 AM, Licensing Program Analysts (LPAs), David Nguyen and Deborah Khashe conducted an unannounced field visit to the facility. Both LPA Nguyen and LPA Khashe were granted entrance into the facility by facility representative/site supervisor, Veronica Gonzalez. LPAs Nguyen and Khashe met with facility representative/site supervisor, Veronica Gonzalez to follow up on the two Unusual Incident Reports (UIRs) reported to Community Care Licensing Division (CCLD) on October 2^nd, 2024, via telephone and on October 3^rd, 2024, via telephone and the two (2) written UIRs reported to CCLD on October 3^rd, 2024, via email.

LPAs Nguyen and Khashe toured the facility, observed the care and supervision of children, reviewed records and conducted onsite interviews with teachers, child, and parent. During today’s field visit, LPAs Nguyen and Khashe toured the facility and observed twenty-six (26) children being supervised by eight (8) teachers.

Facility evaluation report was reviewed and discussed with facility representative/site supervisor, Veronica Gonzalez. Exit interview was conducted. Appeal rights and a notice of site visit were provided. Facility representative/site supervisor’s signature on this form acknowledged receipt of the form. A notice of site visit was posted and must remain posted for 30 days. 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 today’s inspection.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024

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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