<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503810176
Report Date: 02/15/2022
Date Signed: 02/15/2022 05:13:38 PM


Document Has Been Signed on 02/15/2022 05:13 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:DAVIS PARK CHRISTIAN ACADEMY INCFACILITY NUMBER:
503810176
ADMINISTRATOR:GRAY, BUDDYFACILITY TYPE:
850
ADDRESS:901 W RUMBLE RDTELEPHONE:
(209) 642-0597
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:60CENSUS: 0DATE:
02/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Michelle EllisTIME COMPLETED:
02:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/15/2022, Licensing Program Analyst (LPA) Juvenal Moctezuma conducted an announced Prelicensing inspection and met with President - Michelle Ellis, Site Supervisor Angela Madrid, & Teacher Brittany Ellis. LPA explained the reason of the inspection and a tour of the center was conducted both inside and outside. The center is located on the premises of Davis Park Church of Christ on 901 W. Rumble Rd in Modesto, CA. Applicant is requesting a preschool license of 60 preschool children. This program will operate year round from from 7:30 AM to 5:30 PM Monday through Friday. This program plans to operate in five preschool classrooms.

AM Snack, lunch, & a PM snack will be provided by the Center. Food will be prepped in the kitchen by a cook and brought over to each classroom where it will be disbursed for children to eat. The cleaning supplies will be stored in the Janitor Closet down the hall of classroom 10/11 and is closed and locked so children don't have access to it. Staff will utilize the staff bathroom located next to the janitors closet. Ill children will be isolated in the cry room which is in front of the staffs break room. Children will use a stall in the staff bathroom when ill.

The preschool classrooms were observed to be clean and free of toxins. LPA observed that the furniture and equipment appeared to be safe and in good condition. LPA reminded applicant to not store anything on top of the children's cubbies or tall bookcases that could potentially fall on the children. Michelle understood. There is a working carbon monoxide detector in classroom 8/9, 10/11 & another one in the kitchen. Angela stated that there will be a sanitation station at the front entrance of each classroom where staff will do wellness checks every morning during drop off and take the children's and staffs temperatures. Parents will be able to sing their child in through a QR code. Angela stated that the center has a back up in case the QR Code is not working. Masks are worn by staff and children while indoors which are provided by the facility in case parent forgets to bring their own.

Report Continued Onto LIC 809-C

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2022
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: DAVIS PARK CHRISTIAN ACADEMY INC
FACILITY NUMBER: 503810176
VISIT DATE: 02/15/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Room measurements were taken and reviewed with Michelle. The total inside preschool area measured to an approximate 2,211 square feet which will accommodate 60 preschool children. There is adequate storage space available for children's belongings in each classroom. There are enough tables, chairs, & cots for the requested capacity. The cots will be stored in room #12 which is next to the janitors closet and will be brought over to each classroom when needed. This room is not used by preschool children and will be used as extra storage space. Angela stated that quiet play time will be available for non-sleepers. Angela understands that additional staff will be required.

Toys and equipment appear to be age appropriate. Angela stated that bedding/sheets will get taken home for parents to wash every week - Friday or whenever necessary. There are a total of 5 toilets and 4 sinks/hand washing fixtures which will accommodate the requested capacity of 60 preschool children. There are water fountains outside the classrooms (hallway) but Michelle stated that children will bring water bottles which will get refilled here at the center. The center will provide water bottles in case children forget to bring their own. They will take the water bottles when playing outside to have water readily available to them.

The approximate outside square footage for the play area is 4,631 which will accommodate 60 preschool children. The play area is divided into two sections and is gated all around. One Area has the play structure with wood chips as cushioning, 2 basketball hoops, & tables. Michelle stated that they will install a permanent shade structure. The other side is a cemented play area that has a fence all around where children can use bikes and other age appropriate toys to play. Angela stated that children will be escorted through the church off and family room side. LPA reminded staff to have visual supervision of children at all times when transitioning from indoors to outdoors.

A fire clearance for 60 preschool children was received and granted by the Modesto Fire Department on 01/27/2022.

This facility plans to 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

Report Continued Onto LIC 809-C

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: DAVIS PARK CHRISTIAN ACADEMY INC
FACILITY NUMBER: 503810176
VISIT DATE: 02/15/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Michelle was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with Michelle and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed Michelle of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The following items must be completed prior to issuing a license by 03/1/2022.

Preschool

  • Stepping stools for chidlrens bathrooms.
  • Reduce Temperature -hot water in children's bathrooms.
  • Get Toilet caps for all childrens toilets.
  • Remove cleaning supplies underneath childrens bathroom sinks.
  • Chairs for classroom #3.
  • Finish the chain-link fence around the whole play area.
  • Get Permanent shade structured installed
  • Get Age Appropriate sticker for play structure.
  • Repaint structure since rust is showing
  • wrap Poles with cushion to prevent any injuries.

Pending a final file review and completion of above items, a recommendation will be made to license the above facility for a capacity of 60 preschool children.

LPA reviewed with Michelle the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Report Continued Onto LIC 809-C

SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: DAVIS PARK CHRISTIAN ACADEMY INC
FACILITY NUMBER: 503810176
VISIT DATE: 02/15/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The following documents should be posted at the facility:

* PUB 269- Child passenger restraint systems poster 101225(f) Transportation


* Pub 393- Notification of Parents Rights 101218.1(c) Admission Procedures
* License 101160(a) License
* Menus 101227(a)(6) Food Services
* LIC 613A- Personal Rights form 101223(b)(2) Personal Rights
* LIC 610- Disaster Plan 101174(a)
* LIC 9148- Earthquake Preparedness Checklist 101174(b)
* Activity Schedule
* Lead Poisoning brochure

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Michelle Ellis.

No deficiencies cited during today's visit.


A COPY OF THIS REPORT IS TO REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Juvenal MoctezumaTELEPHONE: (559) 580-0275
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4