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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500440
Report Date: 12/06/2023
Date Signed: 12/06/2023 01:12:44 PM

Document Has Been Signed on 12/06/2023 01:12 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:PARVINS HOPELAND PRESCHOOLFACILITY NUMBER:
394500440
ADMINISTRATOR:U.ALGAPPAN/ETHERTON SANDRAFACILITY TYPE:
850
ADDRESS:5965 N PERSHING AVETELEPHONE:
(209) 474-9144
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 35TOTAL ENROLLED CHILDREN: 41CENSUS: 29DATE:
12/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Sandra JohnsonTIME COMPLETED:
01:20 PM
NARRATIVE
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On 12/06/23, Licensing Program Analyst (LPA) Elvira Sierra met with Director, Sandra Etherton for a case management inspection as a result of receiving an unusual incident report. On 12/05/23 an incident occurred, when a child wandered away from the facility through the teacher entrance door located next to the facility office. Staff quickly followed the child after heard the door opening. Child unlocked the door and ran to the street corner. Immediately following the incident, a parent meeting was conducted and a double key lock will be installed on the teacher entrance door.

Per facility representative training staff on topics of transition and supervision are ongoing. Present in the facility were 6 staff supervising 29 children. LPA observed adequate levels of supervision today.

The attached type A deficiency is cited in the next page. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted. Appeal rights were given and discussed with facility representative, Sandra Etherton. A Site Visit Notice was posted and must remain posted for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
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 12/06/2023 01:12 PM - It Cannot Be Edited


Created By: Elvira Sierra On 12/06/2023 at 12:10 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: PARVINS HOPELAND PRESCHOOL
FACILITY NUMBER: 394500440

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/07/2023
Section Cited
CCR
1596.99(c)(3)

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1596.99(c)(3) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues ....:(3) Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.
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Director stated that a double key lock will be installed at the teacher entrance door and a staff meeting checklist with attendance will be submitted to LPA for a plan of correction.
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This requirements was not met as evidence by; Facility self reported an incident ocurred on 12/05/23 that a child wandered away from the facility's grounds. This is a violation that if not corrected poses an immediate risk to the children in care.
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 Civil Penalty of five hunded follars($500.00) will be assess on the next page.

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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: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023


LIC809 (FAS) - (06/04)
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