Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393607283
Report Date: 09/03/2019
Date Signed: 09/03/2019 11:30:41 AM

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: 9DATE:
09/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Brenda DeAlbaTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Stacey Williams met with Brenda DeAlba, Lead Teacher, for the purpose of an unannounced random annual inspection. LPA toured the facility including all activity and classroom space, restrooms, and outdoor play areas. Appropriate ratio and care and supervision were observed during today's inspection. Census included nine (9) preschool children supervised by three staff members. Lead Teacher was reminded never to exceed the conditions, limitations and capacity specified on the license. The facility operates two half day programs in portable #41. Facility hours of operation are Monday through Friday, 8:00AM- 11:30 AM and 12:00 PM- 3:30 PM.

LPA observed circle time activities and classroom play at various stations throughout the center during today’s inspection. Classroom appeared clean including the carpets and floor. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under the climbing equipment are cushioned with enough bark to absorb a fall for outdoor play area. There are trees providing shade for the outdoor play area. Uncontaminated drinking water was readily available to children both indoors and outdoors. There are no firearms or bodies of water on the premises, and the facility has one functioning carbon monoxide detector. Trash cans containing solid waste had lids. LPA observed the classroom to have a first aid kits with the appropriate supplies. Classroom menu was posted. The facility provides breakfast for the morning program and lunch for the afternoon program. Required licensing documentation is posted on the bulletin board in the main entry way of the classroom. LPA reviewed the full signatures for parent sign in/out sheets. LPA observed a current children's roster and fire drill log with the last one conducted in August 2019. Toileting facilities are in safe, sanitary, and operating condition and there are enough sinks and toilets for the children in care. All cleaning supplies were stored inaccessible to children in care and located in locked cabinets.

Report continues on subsequent page, LIC 809C

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019
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: 09/03/2019
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Selected staff and children's records were reviewed, and all required documentation was observed. Emergency information and medical assessments were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification that expires September 2020. Staff criminal record clearances are conducted through the school district. Staff records contain health screenings and documentation of immunizations and mandated reporter training requirements.

This facility is providing Incidental Medical Services-IMS and has a plan of operation in place. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s records. LPA discussed IMS services and the requirement to update the plan of operation. For additional IMS information, LPA advised review of 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.

LPA discussed licensing fees with Lead Teacher and provided a fee printout.

There were no Title 22 deficiencies cited in the areas evaluated during today's inspection.

This facility evaluation report was reviewed and discussed with the Lead Teacher. A notice of site visit was provided and should remain posted for a period of 30 days for parental review. LPA encouraged Lead Teacher to visit the department’s website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation. The implementation of AB 2370, lead exposure was discussed. A copy of this report will remain on file for a period of 3 years for public review upon request. Appeal rights were discussed and provided.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019
LIC809 (FAS) - (06/04)
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