Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607283
Report Date: 10/22/2015
Date Signed: 10/22/2015 03:07:59 PM

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:ADAMS ELEMENTARY SCHOOLFACILITY NUMBER:
393607283
ADMINISTRATOR:WOMBLE, SHARONFACILITY TYPE:
850
ADDRESS:6402 INGLEWOOD AVE.TELEPHONE:
(209) 953-3000
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:24CENSUS: 0DATE:
10/22/2015
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Debra Keller and Jeffery DundasTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Natalie Dunaway met with Administrator, Debra Keller, and Program Manager, Jeffery Dundas for an increase of capacity visit. The program is located in a portable located on the campus of Adams Elementary School.

There is another program that operates in classroom #2 that is a Title 5 program. The program in the portable will be a Head Start program. The program will operate 8 am - 4 pm on the calendar of the Stockton Unified School District.

The classroom measured 1002.2686 square feet, which will be sufficient for the requested 24 children. The outside space measured 4922.9342 square feet, which will be sufficient for the requested 24 children. The total capacity for both programs will be 48 children.

Upon return to the office, LPA will grant an increase of capacity for 48 children.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 229-4537
LICENSING EVALUATOR NAME: Natalie DunawayTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2015
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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