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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393610932
Report Date: 03/29/2021
Date Signed: 03/29/2021 03:51:52 PM

Document Has Been Signed on 03/29/2021 03:51 PM - It Cannot Be Edited

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: 56TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
03/29/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kim PawlowiczTIME COMPLETED:
11:45 AM
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NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via FaceTime was conducted. On Monday, March 29th, 2021, at 10:30 AM, Licensing Program Analyst Elvira Sierra met with Director, Kim Pawlowicz for the purpose of an announced case management tele-inspection. Facility has a current capacity of 56 preschool children; the facility is requesting a decrease in capacity to 24 preschool children and to drop the school-age option. This is a combination center with a preschool and infant program on site. Facility will operate in classroom #136 Monday through Friday from 7:00 AM to 5:30 PM year round. Present in the facility were 3 staff caring for 9 preschool children.

Indoor Activity Space
At 10:45 AM, with the help of the Director, a virtual health and safety inspection in all areas accessible to preschool children was conducted and the preschool classroom was measured; Classroom space measures at 824.025 square feet, allowing for 24 children which will accommodate the requested capacity of 24 children. There are 2 toilets and 3 sinks available to children, and a separate staff restroom is available. LPA observed sufficient amount of furniture, toys, napping mats, cubbies, and play equipment in the classroom. Functional dual carbon and a smoke detectors were observed in the classroom. Disinfectants and medications are inaccessible and appropriately stored. Facility use an electronic sign-in/sign-out system. Children who become ill during the day will be isolated in the main office and will use the staff restroom, if necessary.

Outdoor Active Space


The outdoor play area was previously measured at 10,987 square feet (528 square feet was deducted for the storage shed and electrical boxes). This will accommodate the requested capacity. There is no drinking fountains available outside. Director stated that a water jug and cups are made available to children when they go outside to play. The Director showed LPA a shade structure that is used to provide shade. The outdoor play yard will be used by preschool and infants/toddlers children on a rotated schedule. Director stated that the three groups of children are scheduled to use the playground at separate times. Rotation waiver is on file. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises.
Report continues on subsequent page 809C--
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2021
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: CAPC-CENTRAL 1
FACILITY NUMBER: 393610932
VISIT DATE: 03/29/2021
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Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation, and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

A Fire Clearance was granted on 03/19/21 for the request capacity. Capacity for 24 preschool children is granted effective today 03/29/21. An updated license will be mailed from the regional office.

An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the tele-inspection This facility evaluation report was reviewed and discussed with Director and a copy of this report (LIC 809) and a notice of site visit was email to Director. Director understands she must read the report and send back an acknowledgement that she read and received the report. Notice of Site Visit (LIC 9213) should be posted and remain posted for 30 days. . Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature. Please note: When a physical inspections takes place, requests for alterations may be made.



SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
LIC809 (FAS) - (06/04)
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