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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500284
Report Date: 09/26/2023
Date Signed: 09/26/2023 02:08:29 PM

Document Has Been Signed on 09/26/2023 02:08 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:ANNUNCIATION EXTENDED CAREFACILITY NUMBER:
394500284
ADMINISTRATOR:RODRIGUEZ, SHANNONFACILITY TYPE:
840
ADDRESS:425 WEST MAGNOLIA STTELEPHONE:
(209) 465-2961
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 0DATE:
09/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rodriguez, ShannonTIME COMPLETED:
02:30 PM
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On September 26th, 2023, at 9:15 am, Licensing Program Analyst (LPA), David Nguyen met with Director, Shannon Rodriguez for the purpose of an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. LPA was granted for entrance by Director. Facility days and hours of operation are Monday through Friday from 3:00 PM to 5:30 PM. The Annunciation Extended Care opens from August to May. There were no children present during today's inspection. Meals—PM snacks were provided to school-aged children in care. Filtered water from water dispenser was provided for drinking water. LPA checked that annual fees are not current. LPA reminded the Director to pay the license annual fees.

LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA reviewed first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. 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 (cushioned turf) under the play structure. Due to no school-aged children present at the time of the inspection, LPA did not observe the sign in/out computer printouts. Director stated that the school-aged children were signed in by childcare teachers and signed out by children's parents.

LPA reviewed children’s and staff files. All staff present during today's inspection have a fingerprint clearance. Director 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.

Report continues on 809-C.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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: ANNUNCIATION EXTENDED CARE
FACILITY NUMBER: 394500284
VISIT DATE: 09/26/2023
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LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. LPA observed AB1207 Mandated Reporter training certificates for all staff. The Director was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

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



To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Exit interview conducted and report was reviewed with the Director, Shannon Rodriguez. 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: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC809 (FAS) - (06/04)
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