Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393610932
Report Date: 08/17/2017
Date Signed: 08/17/2017 11:38:51 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:CAPC-CENTRAL 1FACILITY NUMBER:
393610932
ADMINISTRATOR:KIM PAWLOWICZFACILITY TYPE:
850
ADDRESS:540 N. CALIFORNIA ST.TELEPHONE:
(209) 644-5323
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY:56CENSUS: 20DATE:
08/17/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Kim PawlowiczTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Bettina Engelman and met with Kim Pawlowicz, Program Manager, for an unannounced annual/random inspection. Census was 20 children with 4 staff members. A tour of facility was conducted inside and outside. 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 operates form 7 am to 5:30 pm and provides breakfast, lunch and snacks. A menu was posted. LPA observed food preparation areas to be clean and sanitary. Storage containers for solid waste have tight fitting covers. Sign in/sign out sheets are maintained. All staff have criminal record clearance and facility associations. Emergency information and medical assessments were reviewed for some children. Staff records contain health screenings and documentation of immunizations to meet SB 792. At least one staff member has a current CPR/First Aid Certificate expiring August 2019.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 deficiency was observed in the areas that were evaluated today. A Notice of Site Visit was posted and must remain posted for a period of 30 days. An exit interview was conducted.

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

DATE: 08/17/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2017
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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