Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393610932
Report Date: 10/11/2017
Date Signed: 10/11/2017 03:41:08 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: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: 22DATE:
10/11/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Laprice BrownTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Bettina Engelman and Charlotte Baney met with Laprice Brown, Early Education Director, for a case management inspection as a result of receiving an unusual incident report. On 9/29/2017, an incident occurred, when a child wandered away through the open classroom door and into the hallway. Two staff members found the child alone in the hallway and brought the child back to the classroom. Immediately following the incident, a new protocol was implemented, ensuring that classroom doors remain closed. Door bells have been ordered. Per supervisor, training staff on topics of transition and supervision are ongoing. LPAs observed adequate levels of supervision today.

The attached type A deficiency is cited and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted. Appeal rights were given and discussed. A site visit notice was posted and must remain posted for 30 days.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Bettina EngelmanTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2017
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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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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/12/2017
Section Cited
CCR
101229(a)(1
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). The facility self-reported an incident when a child walked out of the classroom and was found in the hallway
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The facility self-reported the incident. Prior to today's inspection, licensee representatives have taken the following measures: implemented a protocol ensuring the classroom doors remain shut while the program is in session; ordered bells for the doors; conducted classroom activities
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without supervision of a teacher.
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on safety and supervision with the children. Licensee representative submitted Agenda and staff signatures on a meeting on supervision conducted with staff involved in this incident, and shall submit evidence of the training conducted with other facility staff and substitutes.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Bettina EngelmanTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2017
LIC809 (FAS) - (06/04)
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