Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607283
Report Date: 05/10/2018
Date Signed: 05/10/2018 02:41:56 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: 36DATE:
05/10/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Brenda De AlbaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Bettina Engelman and met with Brenda De Alba, Teacher, for an unannounced annual/random inspection. Thirty-six (36) preschool-age children and 6 staff members were present. The program conducts part-time sessions in Rooms 1 on the main school building and the Portable Building (the Head Start Building), 8-11:30 am and 12-3:30 pm.

A tour of facility was conducted inside and outside. There was sufficient staff to meet ratio requirements. Drinking water is available both inside and outside. Cleaning solutions and other items that are dangerous to children are kept in a safe place inaccessible to children. Adequate supervision was provided during today’s visit.

The program provides breakfast in the morning and lunch in the afternoon session. Menus were posted. Sign in/sign out sheets are maintained. All staff have criminal record clearance through the school district. Emergency information and medical assessments were reviewed for some children. Staff records contain evidence that staff obtain health screenings, including documentation of immunizations to meet SB 792. LPA observed certificates of Mandated Reporter Training to comply with AB 1207. At least one staff member has a current CPR/First Aid Certificate expiring 4/20.

-- Report continues on subsequent page 809-C
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Bettina EngelmanTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2018
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: ADAMS ELEMENTARY SCHOOL
FACILITY NUMBER: 393607283
VISIT DATE: 05/10/2018
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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

NO DEFICIENCIES WERE CITED in the areas that were evaluated. An exit interview was conducted and a Notice of Site Visit was posted.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Bettina EngelmanTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2018
LIC809 (FAS) - (06/04)
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