Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393610932
Report Date: 05/21/2019
Date Signed: 05/21/2019 11:41:06 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: 44DATE:
05/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kim PawlowiczTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Stacey Williams met with Kim Pawlowicz, Program Director for the purpose of a random annual inspection. LPA toured the facility including all activity and classroom spaces, restrooms, and outdoor play areas. Appropriate ratio and care and supervision were observed during today's inspection. Census included forty-four (44) preschool children supervised by seven staff members. Program Director was reminded never to exceed the conditions, limitations and capacity specified on the license. The facility operates in three classrooms. Two classrooms are full day programs, the third classroom operates two half day programs. Facility hours of operation are Monday through Friday, 7:00AM -5:30 PM.

Classrooms 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 material to absorb a fall. There is a canopy structure 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 functioning carbon monoxide detector. Trash cans containing solid waste had lids. LPA observed the classrooms to have a first aid kits with the appropriate supplies. Classroom menu was posted. The facility provides breakfast, lunch and snack. Required licensing documentation is posted on the bulletin board in the main entry way of the classrooms. LPA reviewed the electronic sign/in-sign/out tablet. LPA observed a current children's roster and fire drill log with the last one conducted in April 3, 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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
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: CAPC-CENTRAL 1
FACILITY NUMBER: 393610932
VISIT DATE: 05/21/2019
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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 for some children. At least one staff member present today has current Pediatric CPR and First Aid certification that expires in April 2021. All staff have criminal record clearance and facility associations. Staff records contain health screenings and documentation of immunizations to meet SB 792.

This facility is providing Incidental Medical Services-IMS and has a plan of operation in place. 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.

This facility evaluation report was reviewed and discussed with the Program Director. A notice of site visit was provided and should remain posted for a period of 30 days for parental review. LPA encouraged Program Director 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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
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