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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500581
Report Date: 05/31/2023
Date Signed: 05/31/2023 03:36:37 PM

Document Has Been Signed on 05/31/2023 03:36 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:LIBERTY SQUARE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
394500581
ADMINISTRATOR:HER, JENNIFERFACILITY TYPE:
850
ADDRESS:807 N. SAN JOAQUIN ST. SUITE BTELEPHONE:
(209) 623-7962
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 17DATE:
05/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Susana VeracruzTIME COMPLETED:
03:50 PM
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On 05/31/23, Licensing Program Analyst (LPA) Elvira Sierra met with Lead Teacher, Susana Veracruz for the purpose of an unannounced annual inspection. Facility representative was reminded never to exceed the conditions, limitations, and capacity specified on the license. Facility hours of operation are; M-F 07:00 am to 05:00 pm inside the Liberty Square Apartment Building. Upon arrival LPA observed 17 napping preschool children and 3 staff.

LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor area. Classroom has age appropriate toys and equipment that are in good repair. Toxic and hazardous items are inaccessible to children. Facility has a fire extinguisher that meets the minimum requirements, operating smoke and a carbon monoxide detectors were observed. Menus were posted and drinking water was readily available to children both indoors and outdoors. Classrooms have appropriate postings. Restrooms were observed clean, in good repair and with adequate supplies. Staff use a separate restroom. Emergency supplies are available and maintained. First Aid Kit is properly maintained and kept inaccessible to children. Drinking water is readily available Indoors/outdoors via pitcher/cups. Playground equipment and surfaces are free of loose or sharp parts. Facility provide meal that are prepared at the central kitchen at the Sutter center. Emergency Drills are conducted monthly and are properly logged. LPA reviewed 5 children's and 3 staff files and are complete and all immunization are up to date.

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.



Report continues on subsequent page 809C--
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2023
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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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: LIBERTY SQUARE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 394500581
VISIT DATE: 05/31/2023
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This facility provides Incidental Medical Services – IMS. 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/inspection-process.

Exit interview conducted. This Report and Appeal of Rights were provided and reviewed with the facility representative, Susana Veracruz.. Notice of Site Visit posted and must remain posted for 30 days.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC809 (FAS) - (06/04)
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