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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621424
Report Date: 02/16/2023
Date Signed: 02/16/2023 01:56:31 PM

Document Has Been Signed on 02/16/2023 01:56 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:LIVE OAKFACILITY NUMBER:
393621424
ADMINISTRATOR:LOPEZ, MARY LISAFACILITY TYPE:
850
ADDRESS:5099 BEAR CREEK ROADTELEPHONE:
(209) 331-7252
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 15DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Therese ZerkaTIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Erwin Tjhia and Licensing Program Manager (LPM) Bettina Engelman met with Therese Zerka, Site Supervisor, for an unannounced annual/random inspection. Fifteen preschool-age children and one staff member was present. The program is located at the Room 12 on the campus of Lodi Live Oak Elementary School 08:00 a.m. to 2:00 p.m.

The staff was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. All staff have criminal record clearances through the Lodi Unified School District. All staff have a health screening report and immunization, documentation of the educational background and experience.

A tour of facility was conducted inside and outside. Room 12 has a bathroom with two toilets and two sinks. LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA observed all required forms to be posted. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (artificial grass) under the play structure. LPA reviewed the sign in/out book and observed that the children are properly signed in/out.


Ten children files were reviewed during today inspection. The staff files were reviewed showing current CPR/First Aid certificate expiring on 01/15/2024. LPA observed AB1207 Mandated Reporter training certificates for all staff. The staff was reminded to renew the course every 2 years through www.mandatedreporterca.com website.
Report Continue on 809-C
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: LIVE OAK
FACILITY NUMBER: 393621424
VISIT DATE: 02/16/2023
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This provider is not currently providing Incidental Medical Services (IMS) services to children in care. IMS policy was discussed.

For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Exit interview conducted and report was reviewed with the staff. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



In the areas that were evaluated, no deficiencies were cited during the inspection.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023
LIC809 (FAS) - (06/04)
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