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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500242
Report Date: 08/20/2021
Date Signed: 08/20/2021 03:32:00 PM

Document Has Been Signed on 08/20/2021 03:32 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:HOOVER ELEMENTARYFACILITY NUMBER:
394500242
ADMINISTRATOR:PICHARDO, MAYTEFACILITY TYPE:
850
ADDRESS:2900 KIRK STTELEPHONE:
(209) 933-7215
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
08/20/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Jennifer CohenTIME COMPLETED:
03:40 PM
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On August 20 2021 at 2:10 p.m. Licensing Program Analyst (LPA) Aruna Sridharan met with Head teacher Jennifer Cohen for an annual inspection. Facility operates in room N9 classroom M-F from AM class 8:00 am to 11:00am and PM class 12:00 to 3:00pm year round. Present during the inspection was 1 staff. The census for today was three children.

At 02:15 p.m. LPA inspected the facility indoors and outdoors for health and safety hazards and observed the following; Classrooms have age appropriate toys and equipment that are in good repair. Cubbies are located inside the classrooms for children’s belongings. Facility has sufficient napping equipment for children in care. Medications and cleaning products and Toxins are maintained inaccessible to children. Facility don’t have any children that required medication at this time. Restrooms are maintained clean, in good repair and with adequate supplies. Staff use a separate restroom. The isolation area for ill children is in the director office and the use of the staff restroom if needed. Drinking water is readily available Indoors via pitcher/cups and children have their own label bottle water that teachers bring outdoors for children if needed. Facility has a fire extinguisher that meets the minimum requirements, a smoke and a carbon monoxide detector. Outdoor play area is free from hazards and dangerous conditions.

Emergency supplies, first aid kit are available and maintained. Classrooms has appropriate postings. Emergency Drills are conducted monthly and are properly logged. Program provide breakfast and lunch which is supplied by the school cafeteria. . LPA discussed with the director that the person who signs a child in/out uses their full legal signature and records the time of day. All three children’s files and staff files were reviewed. Children's files contain a medical assessment and emergency contact ID information. Staff files contain a health screening. At least one staff member present today has current Pediatric CPR and First Aid certification.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulations and Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

No deficiencies were cited in today's inspection. A notice of Site Visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative.
SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Aruna Sridharan
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: HOOVER ELEMENTARY
FACILITY NUMBER: 394500242
VISIT DATE: 08/20/2021
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Director 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.


Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulations and Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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

A notice of Site Visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director.
SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Aruna Sridharan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC809 (FAS) - (06/04)
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