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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500375
Report Date: 05/22/2024
Date Signed: 05/22/2024 02:49:18 PM

Document Has Been Signed on 05/22/2024 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 - MAINFACILITY NUMBER:
394500375
ADMINISTRATOR/
DIRECTOR:		NORIEGA, BLANCAFACILITY TYPE:
850
ADDRESS:800 E MAIN STTELEPHONE:
(209) 851-3479
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY: 34TOTAL ENROLLED CHILDREN: 25CENSUS: 17DATE:
05/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Connie Mejia and Kim Ballard TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 05/22/24, Licensing Program Analysts (LPAs) Elvira Sierra and Stacey Williams met with Facility Representative Connie Mejia Chavez for an unannounced Case Management Inspection visit. ECE Director, Kim Ballard and Assistant ECE Director, Blanca Noriega arrived later during the inspection. Present in the facility were five staff and 17 children.

The purpose of the inspection was explained and was to follow up on an unusual incident that occurred on 05/02/24; which was self-reported to the department by the facility. Facility reported that during circle time Staff#1 used inappropriate discipline towards a daycare child. Facility representatives stated that Staff #1 no longer works at the facility.
During the investigation of the incident LPA Sierra conducted interviews with staff #1, the staff that witnessed the incident and with ECE Directors.
A Title 22 deficiency was cited on the subsequent page of this report. An exit interview was conducted, and appeals rights were discussed with facility representatives Kim Ballard and Blanca Noriega. Notice of Site Visit was posted.

Facility representatives acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiency for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee (LIC 9224 was provided).
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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Document Has Been Signed on 05/22/2024 02:49 PM - It Cannot Be Edited


Created By: Elvira Sierra On 05/22/2024 at 02:15 PM
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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CAPC - MAIN
FACILITY NUMBER: 394500375

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2024
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment ……This requirement was not met as evidence by.
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POC; ECE Director, Kim Ballard stated staff #1 no longer work at the facility. Facility had a staff meeting after the incident; Personal Rights and discipline policies were discussed with staff during staff meeting. Facility will provide a copy of the agenda and signature page to LPA by the due date.
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Facility reported an incident that occurred on 05/02/24. It was reported that staff # 1 used inappropiate discipline towards a daycare child. This is a violation that if not corrected pose an immediate risk to the health and safety to the 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:Bettina Engelman
LICENSING EVALUATOR NAME:Elvira Sierra
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024


LIC809 (FAS) - (06/04)
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