393611645-9-5-2024-53-CC-ETJA-D8TSCB-20240905134515

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 393611645
Report Date: 09/05/2024
Date Signed: 09/05/2024 01:45:18 PM

Document Has Been Signed on 09/05/2024 01:45 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	CAMP HUTCHINS OF LODI MEMORIAL HOSPITAL		FACILITY NUMBER:	393611645
ADMINISTRATOR/ DIRECTOR:	SANDRA ETHERTON		FACILITY TYPE:	850
ADDRESS:	125 SOUTH HUTCHINS STREET		TELEPHONE:	(209) 334-2267
CITY:	LODI	STATE: CA	ZIP CODE:	95240
CAPACITY: 53	TOTAL ENROLLED CHILDREN: 53	CENSUS: 22	DATE:	09/05/2024
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:45 PM
MET WITH:	Sandra Johnson		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

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On 09/05/2024, Licensing Program Analysts (LPAs) Erwin Tjhia and Deborah Khashe conducted a case management inspection to verify corrections of deficiencies cited on 08/29/2024. LPAs were greeted by Site Supervisor, Sandra Johnson. There were 22 children, including 2 Kindergarten children supervised by 4 staff. LPA did not observe any school age children today and was informed by site supervisor that there were only 11 school age children enrolled.

On 08/29/2024, the facility was cited for two Type A deficiencies for operating beyond the conditions and limitations specified on the license by having 35 school age children on 07/09/2024, and for teacher-child ratio as one teacher supervised for more than 14 school age children in two different occasions (07/09/2024 and 08/01/2024)

During today's inspection LPA toured all areas and observed 22 children ( 20 Preschoolers and 2 kindergarten) being supervised by 4 staff, and there were no School age children present.

Both deficiencies cited on 08/29/2024 for operating beyond the conditions and limitations specified on the license, and for teacher-child ratio can be cleared today.

LPA reminded the site supervisor that the LIC 9224 Acknowledgment Forms will need to be signed by the parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.

An exit interview was conducted and Notice of Site Visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal rights were discussed and a printed version was given to licensee.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024

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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