Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620823
Report Date: 05/11/2017
Date Signed 05/11/2017 01:35:52 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: 19DATE:
05/11/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Veronica KelleyTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kiriko Pratt met with Site Coordinator Veronica Kelley for the purpose of an annual random visit. LPA toured the building including all activity and classroom spaces, restrooms, food service, and outdoor play areas. LPA observed appropriate ratios, care and supervision, and capacity during the visit.

Medical supplies, disinfectants, cleaning solutions, and hazardous items were appropriately stored and inaccessible to children. Furniture, equipment, and play materials were in good condition. Playground equipment was free of loose and sharp parts. The areas under and around playground climbing equipment were cushioned with materials to absorb falls. Toileting facilities were in operating, safe, and sanitary condition. The food preparation area was visibly clean, free of litter and rubbish. All food was protected against contamination. Trash cans containing solid wastes had lids. Uncontaminated drinking water was readily available to children both indoors and outdoors. Menus were posted in a visible area. LPA observed Sign In/Out Sheet with signatures, times, and dates.

Incidental Medical Services (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
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Kiriko PrattTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2017
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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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: CAPC - GOLDEN WEST
FACILITY NUMBER: 393620823
VISIT DATE: 05/11/2017
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Children’s records were reviewed and included contact information of responsible parties and medical assessments. At least one staff member present today had current Pediatric CPR and First Aid certification (expires 06/2018). All staff currently employed with the facility have criminal record clearances, a health screening, and documentation of qualifications including education and experience. LPA observed age appropriate furniture and equipment. The indoor and outdoor space was physically separated from the school-age children's space on the school site. No weapons or bodies of water are located at the facility. LPA discussed the Departmental inspection authority, and also informed the Site Coordinator that any changes regarding the Center Director or their Designee must be reported to Department within 10 working days.

An Exit Interview was conducted. A Notice of Site Visit was provided. Site Coordinator was encouraged to the visit the Departmental website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers.

No Title 22 Deficiencies were cited during today's visit.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Kiriko PrattTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2