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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620682
Report Date: 08/14/2023
Date Signed: 08/14/2023 09:26:38 AM

Document Has Been Signed on 08/14/2023 09:26 AM - 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:CAP KERN EARLY HEAD START PROGRAM - CALIFORNIA ST.FACILITY NUMBER:
393620682
ADMINISTRATOR:TINA MOUAFACILITY TYPE:
830
ADDRESS:425 NORTH CALIFORNIA STREETTELEPHONE:
(209) 242-9540
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY: 24TOTAL ENROLLED CHILDREN: 16CENSUS: 13DATE:
08/14/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gloria BarberoTIME COMPLETED:
10:00 AM
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Application Specialist (AS) Alecia Sifuentes met with Assistant Director, Gloria Barbero for the purpose of a case management inspection. Licensee requests to change the infant age range back to 0 to 24 months. Licensee is not making any changes to the licensed capacity. AS observed on file the most current fire inspection report (STD850) from 10/7/2015 is granted for ages 0-24 months and 18-36 months therefore an updated STD850 was not required. The program operates Monday through Friday from 7:30 a.m. to 5:30 p.m.

INDOOR ACTIVITY SPACE:
AS observed one infant classroom and two toddler classrooms. Assistant Director stated that no changes have been made since licensure. AS observed a nap area towards the right side of the infant classroom. AS observed 6 cribs and 16 napping cots. Assistant Director acknowledges there will be a maximum of 6 infants under 12 months old, due to available cribs. AS used current measurements from report dated 10/27/2015 therefore AS did not take measurements. The total classroom spaces contain a total of 1,481 square feet, which will accommodate the current licensed capacity of 8 infants and 16 toddlers. There is a child's restroom which includes 4 toilets and 3 sinks for the toddler children. There is an additional 2 sinks in the toddler classroom and 3 sinks in the infant classroom. There is a separate private restroom for the staff. AS observed a sink within arm’s reach of a changing table in the infant and toddler classrooms.

Assistant Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Report continues on LIC809-C.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2023
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CAP KERN EARLY HEAD START PROGRAM - CALIFORNIA ST.
FACILITY NUMBER: 393620682
VISIT DATE: 08/14/2023
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Assistant Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Assistant Director, Gloria Barbero.

Effective today, 8/14/2023, AS will update the age range on the license to serve 8 children from age 0-24 months (with a maximum census of 6 infants under 12 months old due to available cribs) and 16 toddlers age 18-36 months under the Toddler Option Program.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
LIC809 (FAS) - (06/04)
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