Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607283
Report Date: 10/26/2016
Date Signed: 10/26/2016 12:48:52 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:48CENSUS: 14DATE:
10/26/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Brenda De AlbaTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Emerita Curiel met with the preschool teacher for an annual/random visit. LPA toured the facility, including all activity/classroom number 1, restrooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications and first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions. Two teachers, one substitute teacher, a school nurse, and 14 children were present today. The facility operates two half day classrooms from 8:00 am to 11:30 am and 12:00 pm to 3:30 pm.

LPA observed all required forms to be posted. Facility stores medication in a lockbox. There are adequate toys and equipment available for children. The restrooms were observed to be in working. The facility provides breakfast for the morning class and Lunch for the afternoon class. Food is prepared at the school cafeteria. Menus were posted in the classroom.

LPA reviewed the sign/in-sign/out sheet, children's and personnel records. All reviewed children's files had admission agreements. LPA observed proof of education requirements for staff. At least one staff member present today has current Pediatric CPR and First Aid. LPA discussed new 2016 law that passed including staff immunization changes. All staff are immunized with the required vaccinations. All staff currently employed with the Center has criminal record clearances. Fire extinguisher and smoke detector meet regulation.

This facility is providing Incidental Medical Services-IMS and have a plan of operation in place. LPA discussed IMS services and the requirement to update the plan of operation. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173. LPA provided the Licensing Agency website www.ccld.ca.govthe director and/or staff may obtain updated licensing information, regulations, and forms.

The facility is in substantial compliance today. Exit interview conducted. Discussed and reviewed this annual report. Notice of Site Visit was posted.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Emerita CurielTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2016
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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