Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620823
Report Date: 03/13/2017
Date Signed 03/13/2017 12:54:58 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:SILVA, REBECCAFACILITY TYPE:
850
ADDRESS:1031 NORTH MAIN STREETTELEPHONE:
(209) 644-5311
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:24CENSUS: 17DATE:
03/13/2017
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Jade Meihl TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Bettina Engelman met with Jade Meihl, Division Manager, for a Case Management Visit. Also present was Nancy Leal, Director of School Readiness, Manteca Unified School District.

The purpose of the visit was to evaluate and measure the new playground the facility had recently installed. The facility is currently using the playground that was in place at the time of licensure. Since then, the facility had added an additional playground to the east of the building.

The new playground features a large climbing structure, with areas under and around it sufficiently cushioned with tan bark. LPA measured the area to be 1,805 square feet, sufficient for the licensed capacity of 24. The shade structure used on the current playground will be moved to that new area, once approved. Drinking water will be brought out in a water jug.

The playground is surrounded by a 3'6" tall fence, which has an opening for a gate. Licensee representatives stated that they anticipate the gate to be installed soon, and that they will notify LPA when installation is complete. The facility is on the campus of an elementary school, which is surrounded by an 8 feet tall perimeter fence. LPA will follow up with Licensing Manager on the need for a waiver to approve the fence. Once LPA has clarification on fence waiver requirement, and has received photographs on the fence gate, the new area will be approved for use.

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

DATE: 03/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2017
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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