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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 050320948
Report Date: 09/07/2023
Date Signed: 09/07/2023 04:35:53 PM


Document Has Been Signed on 09/07/2023 04:35 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:RESOURCE CONNECTION OF AMADOR&CALAVERAS,SAN ANDREAFACILITY NUMBER:
050320948
ADMINISTRATOR:KOMOL KAMDROGRUBFACILITY TYPE:
850
ADDRESS:501 GOLD STRIKE ROADTELEPHONE:
(209) 754-1600
CITY:SAN ANDREASSTATE: CAZIP CODE:
95249
CAPACITY:49CENSUS: 11DATE:
09/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ashley Anderson, Facility RepresentativeTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Tobias Lake met with facility representative, Ashley Anderson, for the purpose of an unannounced annual inspection. Facility days and hours of operation are Tuesday-Friday from 7:30 AM to 02:30 PM. There were 11 children present during today's inspection. There were four staff present, three teachers and one cook. LPA checked that annual fees are current.

LPA toured the facility inside and out. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA reviewed and verified staffing ratios, first aid supplies, furniture, fire drills, equipment, 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 (rubber flooring) under the play structure. LPA reviewed the sign in/out sheets and observed that the children are properly signed in. Facility prepares breakfast, lunch, and afternoon snack on grounds.

All staff present during today's inspection have a fingerprint clearance. Licensee 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.

LPA reviewed children’s and staff files. LPA observed health screening reports with TB test and required MMR and TDAP vaccines for all staff members. All staff members present today have current Pediatric CPR and First Aid as well as their Mandated Reporter Training Certificates. The facility was reminded to renew the course every 2 years through www.mandatedreporterca.com website.
Report continues on 809-C.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Tobias LakeTELEPHONE: 916-224-9388
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023
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: RESOURCE CONNECTION OF AMADOR&CALAVERAS,SAN ANDREA
FACILITY NUMBER: 050320948
VISIT DATE: 09/07/2023
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Incidental Medical Services (IMS) policy was discussed. Facility has plans in place and was reviewed at time of inspection. 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 facility representative, Ashley Anderson. 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.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Tobias LakeTELEPHONE: 916-224-9388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC809 (FAS) - (06/04)
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