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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620682
Report Date: 10/05/2023
Date Signed: 10/05/2023 03:07:38 PM

Document Has Been Signed on 10/05/2023 03:07 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: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: 24CENSUS: 24DATE:
10/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Patricia MexicanoTIME COMPLETED:
03:20 PM
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On 10/05/23, Licensing Program Analyst (LPA) Elvira Sierra met with Site Supervisor, Patricia Mexicano for the purpose of an unannounced annual inspection. Form (LIC 125), Entrance Checklist for Child Care Centers, was provided to facility representative. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Census included 24 children supervised by seven staff. This is a combination center of infant with a toddler option on site. The facility uses three classrooms. Facility hour of operation are Monday through Friday 07:30AM to 05:15PM. Per facility representative the facility closes every third Wednesday of the month for staff development training

LPA toured the facility including all activity and classroom spaces, restrooms, food service, and outdoor play areas. LPA observed the required documents to be posted in a prominent, publicly accessible area at the facility. Toxic and hazardous items were inaccessible to children. Age-appropriate furniture, and play equipment were observed to be in good repair. LPA observed sufficient napping equipment for the children in care. Infant changing stations were clean with essential supplies to clean and disinfect the changing area. The floors appeared clean throughout the facility. The food preparation space was free of litter and all food is protected against contamination. LPA observed that storage containers for solid waste and diaper disposal have tight-fitting covers. Per facility representative program provides meals and or baby food if needed. Per facility representative all children currently enrolled do not required baby food or formula. Facility representative stated that infant's blankets are wash after every use and toddler's blankets are wash at least once a week or as needed. Blankets are provided by the facility. Medication is kept in every classroom on a upper cabinet and also in a red emergency backpack. LPA reviewed storage of medication. Menus are posted in the classroom and drinking water was readily available to children both indoors and outdoors via pitcher and cups. LPA reviewed signing in/out sheets. Facility also uses electronic sign in/out and head count list. LPA reviewed sleeping logs. LPA observed functioning fire extinguisher and carbon monoxide/smoke detectors. Outdoor play area is fenced for supervision. Playground equipment and surfaces were observed free of any hazards. Report continues on subsequent page 809C---

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 10/05/2023
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Five children's records and five staff files were reviewed and are complete containing required licensing forms. At least one staff member present today has current Pediatric CPR and First Aid certification.
Facility representative 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.
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
Report continues on subsequent page 809C--
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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: 10/05/2023
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Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child 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 facility representative, Patricia Mexicano.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC809 (FAS) - (06/04)
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