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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500030
Report Date: 10/26/2023
Date Signed: 10/26/2023 02:49:35 PM

Document Has Been Signed on 10/26/2023 02:49 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:CAPC - GREAT VALLEYFACILITY NUMBER:
394500030
ADMINISTRATOR:CARTER, STACEYFACILITY TYPE:
850
ADDRESS:4223 MCDOUGALD BLVDTELEPHONE:
(209) 851-3479
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 13DATE:
10/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:Lead Teacher Stacy CarterTIME COMPLETED:
03:15 PM
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On 10/26/23, Licensing Program Analyst (LPA) Carla Polanco met with Facility Representative Stacy Carter for an unannounced annual inspection. Facility operates in room #53. Upon arrival, LPA observed 13 preschool-age children supervised by Site Supervisor and two qualified staff members. Facility hours of operation are Monday through Friday, 7:45 AM to 10:45AM (morning session) and 12:15 PM to 3:15 PM (afternoon session). Facility representative stated that the program is only operating out of room #53 at this moment and room #55 is no longer used.

LPA toured all activity and classroom spaces, restrooms, and outdoor play areas. Storage intended for medications is inaccessible to children in care. Facility Representative stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with bark to absorb the fall. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Facility provides snacks for morning and afternoon classes, which are provided by the school's food program. There is no kitchen in the classroom, but there is a fridge where snacks are stored. Menus are posted and drinking water is readily available to children. LPA observed the device used for electronic sign-in and out.

Three staff and 5 children's records were reviewed. Each child's file contained an emergency card. At least one staff member present today has current Pediatric CPR and First Aid certification (Exp. 4/2025).

Report continues on LIC809-C.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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 2
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: CAPC - GREAT VALLEY
FACILITY NUMBER: 394500030
VISIT DATE: 10/26/2023
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 All staff currently employed with the facility have a criminal record clearance, health screening report, mandated reporter certificates, and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with Facility Representative any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

The facility does not have any children needing Incidental Medical Services (IMS) at this moment. 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 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/process.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility Representative was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. LPAs provided and discussed Effects of Lead Exposure brochure. In the areas that were evaluated, no deficiencies were cited on today’s date.

Exit interview was conducted and report was reviewed with Facility Representative. A Notice of Site Visit was provided and should remain posted for a period of 30 days.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC809 (FAS) - (06/04)
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