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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622598
Report Date: 05/30/2023
Date Signed: 05/30/2023 12:52:06 PM

Document Has Been Signed on 05/30/2023 12:52 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CHIMINIKE'S PRESCHOOL LEARNING CENTER - LLCFACILITY NUMBER:
393622598
ADMINISTRATOR:PICOS, MERARYFACILITY TYPE:
850
ADDRESS:6608 GRIGSBY PLACETELEPHONE:
(209) 451-0583
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 35DATE:
05/30/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Merary PicosTIME COMPLETED:
01:00 PM
NARRATIVE
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On May 30th, 2023, at 9:30 am, Licensing Program Analysts (LPAs), Lauren Scott and David Nguyen conducted an announced field visit to the facility. LPAs arrived at the facility and was met by Director Merary Picos (D1). LPAs disclosed the purpose of the inspection and were granted entrance into the facility. Upon arrival, LPAs observed one (1) preschooler in the toddler classroom, which poses an potential health, safety or personal rights risk to persons in care.

A Type B violation was assessed on a subsequent 809-D page. An exit interview was conducted, and the report was reviewed with D1. Licensee Appeal Rights were provided to D1. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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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Document Has Been Signed on 05/30/2023 12:52 PM - It Cannot Be Edited


Created By: David Nguyen On 05/30/2023 at 11:48 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CHIMINIKE'S PRESCHOOL LEARNING CENTER - LLC
FACILITY NUMBER: 393622598

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/30/2023
Section Cited
HSC
1596.955(a)(2)

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Child Day Care Centers Serving....Optional Program
Parents give permission for the placement of their children in the toddler program.
This requirement is not met as evidenced by:
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Teachers will ensure all children placed in the toddler program will have written permssions from the parents prior to participating in the Toddler Classroom.
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Upon arrival, LPAs observed one (1) child not enrolled in the Toddler Classroom, which poses an immediate health and safety or personal rights risks to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023


LIC809 (FAS) - (06/04)
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