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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500375
Report Date: 08/30/2024
Date Signed: 08/30/2024 03:01:52 PM

Document Has Been Signed on 08/30/2024 03:01 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: 34CENSUS: 7DATE:
08/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Alexandra LariosTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
NARRATIVE
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On 08/30/24 Licensing Program Analyst (LPA) Elvira Sierra met with Alexandra Larios to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 08/20/24. Present in the facility were three staff supervising seven children. ECE Director, Kim Ballard arrived later during the inspection.

During today's inspection LPA observed the care and supervision of the children, reviewed documents and conducted interviews. The facility reported an unusual incident report (UIR) to Community Care Licensing within 24 hours that occurred on 08/19/24. It was reported that around 11:00am, on 08/19/24 one child was left unsupervised in the center’s fenced playground area for approximated 5 minutes. As the classroom # A and #B were transitioning inside the facility after outdoor play time. Upon entrance to the classroom a head count was conducted by a teaching staff and noticed that child #1 was missing. Child # 1 was found alone standing in the playground area. Per Director child was not scared or upset, and that the staff notified the parents. Director provided copies of a written plan and training notes that were reviewed with staff detailing the supervision of children in care.

The following Title 22 Deficiency is being cited on the subsequent 809-D page. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, acknowledging receipt of LIC 809-D in each child's file. Exit interview conducted. This report and Appeal Rights were reviewed and provided to facility representative, Alexandra Larios. Notice of Site Visit was posted and must remain posted for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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 08/30/2024 03:01 PM - It Cannot Be Edited


Created By: Elvira Sierra On 08/30/2024 at 02:52 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: 08/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/02/2024
Section Cited
CCR
101229(1)

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101229 Responsibility for Providing Care and Supervision a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This regulation was not met as evidence by;
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POC; Director provided copies of a written plan and training notes that were reviewed with staff detailing the supervision of children in care via email on 08/27/24.


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On 08/19/24 Child # 1 was left unsupervised on the center’s fenced playground for approximately 5 minutes. This is a requirement that if corrected poses an immediate risk to the health and safety of 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: 08/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2024


LIC809 (FAS) - (06/04)
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