Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621283
Report Date: 09/09/2016
Date Signed: 09/14/2016 11:25:34 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 - PITTMANFACILITY NUMBER:
393621283
ADMINISTRATOR:CARTER, STACEYFACILITY TYPE:
850
ADDRESS:521 E. MINERTELEPHONE:
(209) 644-5311
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY:24CENSUS: 0DATE:
09/09/2016
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Kim BallardTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Emerita Curiel and Licensing Program Manager (LPM) Jennifer Brekke met with Kim Ballard for the purpose of a change of location and change of capacity. The facility is requesting to decrease their preschool license from 32 to 24 infants. Licensing staff measured the infant classroom. The indoor activity area measured a total of 900 square feet and can accommodate 24 children . The hours of operation are 7:00 am to 5:30 pm.

Fire clearance has been granted for the decreased capacity request.

INDOOR ACTIVITY SPACE:

The room is equipped with child size furnishings. There are individual cubbies for storing children's personal belongings. Food will be provided by the child abuse prevention council central kitchen and delivered to the classroom. LPAs observed a complete first aid kit. be provided by the child abuse prevention council central kitchen and delivered to the classroom. There will be a water dispenser a cups available to children. There is a separate staff bathroom available for staff use only.

There was one room measured for the preschool program. The room contains a total of 900 square feet which will accommodate the applicant's request for 24 preschool children. There are two toilets and three sinks for the preschool children.

Continue 809-C

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Emerita CurielTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2016
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 - PITTMAN
FACILITY NUMBER: 393621283
VISIT DATE: 09/09/2016
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Outdoor Active Space

The outdoor activity area measured a total of 3005 square feet which is enough space to accommodate 40 children. Currently the outdoor space is a black top area that is fenced. LPA's observed the bottom section of the chain link fencing is not properly secured to the poles. There is also a large gate that has some long steel bars that have broken off part of the gate that are sharp and hazardous. Kim stated that the entire fencing will be replaced on September 19. The outdoor play space does not have any shade. Kim stated that there will be several large umbrellas installed in the outdoor activity area. Kim stated that a new playground will be installed on September 12. Licensee also stated Licensing representative has requested a shared space waiver for their outdoor activity space that is shared with their preschool program.

The following items need to be corrected prior to a license being issued:

1) Repair or replace outdoor fencing

2) Install playground equipment.

5) There is about a 9 inch lip on the door way that is a potential tripping hazard. Licensee stated that a ramp will be installed to eliminate the gap.

There were no deficiencies cited during today's visit. Notice of Site Visit provided.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Emerita CurielTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2016
LIC809 (FAS) - (06/04)
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