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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622010
Report Date: 02/07/2024
Date Signed: 02/07/2024 03:10:11 PM

Document Has Been Signed on 02/07/2024 03:10 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:CAPC - SBS IWFACILITY NUMBER:
393622010
ADMINISTRATOR:SYHACHACK, MOMEFACILITY TYPE:
830
ADDRESS:540 NORTH CALIFORNIA STREETTELEPHONE:
(209) 644-5311
CITY:STOCKTONSTATE: CAZIP CODE:
95202
CAPACITY: 39TOTAL ENROLLED CHILDREN: 24CENSUS: 19DATE:
02/07/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Mome SyhachackTIME COMPLETED:
03:30 PM
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On 02/07/24, Licensing Program Analyst (LPA) Elvira Sierra met with Center manager, Mome Syhachack for the purpose of an unannounced annual inspection. Director was reminded never to exceed the conditions, limitations and capacity specified on the license. Census included 9 infants and 10 toddlers being supervised by 7 staff members. Form (LIC 125), Entrance Checklist for Child Care Centers, was provided to Facility Representative. All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. Facility hours of operation are Monday through Friday from 6:00 AM to 6:30 PM. Facility is a combination center with a preschool license on site.
LPA toured the building including all activity and classroom spaces, restrooms, food service, and outdoor play areas. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. Infant changing tables have a padded surface that is washable. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. LPA observed that storage containers for solid waste and diaper disposal have tight-fitting covers. LPA observed that the infant's bottles are labeled, and staff will sanitize and clean the bottles daily. Program provides breakfast, lunch, and afternoon snacks for toddlers and infants who are on solids. Formula for infants is provided by the facility. Menus were posted and drinking water was readily available to children both indoors and outdoors via pitcher and cups. Facility representative stated that Alhambra water is deliver to the facility at least twice a month. Facility uses electronic sign in/out system. LPA observed the infant's Needs and Services Plans are current. LPA reviewed infant sleeping logs.
Staff and children's records were reviewed and are complete containing required documentation by Licensing. Staff files that were reviewed have a current Pediatric CPR and First Aid certification.
Facility representative was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.
Report continues on subsequent page 809-C.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2024
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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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: CAPC - SBS IW
FACILITY NUMBER: 393622010
VISIT DATE: 02/07/2024
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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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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
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 licensee 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.
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.
Facility representatives were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative,

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC809 (FAS) - (06/04)
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