Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620823
Report Date: 08/29/2016
Date Signed 08/29/2016 01:45:08 PM

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:CAPC - GOLDEN WESTFACILITY NUMBER:
393620823
ADMINISTRATOR:BERRIOS, JAMIEFACILITY TYPE:
850
ADDRESS:1031 NORTH MAIN STREETTELEPHONE:
(209) 644-5311
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:24CENSUS: 18DATE:
08/29/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Michelle JosephTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Bettina Engelman met with Michelle Joseph, Program Manager, for a Case Management Visit. Also present was Nancy Leal, Director of School Readiness with Manteca Unified School District, and Rebecca Silva, Site Coordinator. The program operates part-day classes in Room P9 on the campus of Golden West Elementary School.

At the time of licensure, the room was referred to as Room 36. Over the summer months, the school has been renovated, and the room is now referred to as Room P9. The purpose of today's visit was for LPA to document changes that have been made to the facility in regards to bathroom location and playground. At the time of licensure, the facility used school bathrooms located at the end of a building to the south of the building that houses the preschool classroom. A waiver for shared use of bathrooms has been granted and is posted.

Since the beginning of this school year, the facility has been using the girls' bathrooms, which are located across the walkway from the end of the building to the south of the classroom. In addition, a bathroom, which houses one toilet and a sink and is located in the building to the south of the preschool classroom, is utilized. LPA reminded facility staff of their responsibility to provide supervision and maintain mandated adult:child ratios as they escort children to the bathroom.

The facility is still using the same playground as during licensure. A new playground has been installed to the east of the preschool building. Once fenced in, facility will request use of that newly designated outside area and submit an updated facility sketch.

No deficiencies were cited at today's visit. An exit interview was conducted and a Notice of Site Visit was posted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Bettina EngelmanTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2016
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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