310317468-2-18-2020-03-CC-KOWS-BLWTAK-20200218133339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 310317468
Report Date: 02/18/2020
Date Signed: 02/18/2020 01:33:43 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:	ADVENTURE CLUB - CIRBY		FACILITY NUMBER:	310317468
ADMINISTRATOR:	NETT, MELANIE		FACILITY TYPE:	840
ADDRESS:	814 DARLING WAY		TELEPHONE:	(916) 772-4818
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95678
CAPACITY:	60	CENSUS: 0	DATE:	02/18/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Breanna Montgomery Site Coordinator Program Assistant		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced annual/random inspection is made today by Licensing Program Analyst Owens. LPA Owens met with Breanna Montgomery, Site Coordinator Program Assistant. A tour of facility was conducted inside and outside. No children were present during inspection. The following areas are in compliance during inspection: There are no bodies of water. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted according to Title -22 Regulations. The playground equipment and outdoor activity space is maintained and in good condition. There is adequate shade on the playground. Carbon Monoxide detector is on the premises. Rooms are safe and clean. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered and all food or beverages are stored in covered containers at 45 degrees or less. The facility provides lunch and AM /PM snack. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. There is adequate space for children belongings. Sign in/sign out sheets maintained. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Staff records reviewed contain documentation of the educational background, training, and/or experience. This facility is located on Cirby Elementary School grounds in Adventure Club Portable. Operating hours are Monday thru Friday; 6:30 AM to 6:00 PM on non-school days. Continued on page 2

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020

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: ADVENTURE CLUB - CIRBY	FACILITY NUMBER: 310317468
	VISIT DATE: 02/18/2020

NARRATIVE

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LPA observed proof that all staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

LPA discussed the new Safe Sleep in Child Care regulation and discussed the Effects of Lead Exposure brochure. The facility has the lead brochure and all parents are given a copy.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Incidental Medical Services (IMS) policy was discussed, the facility is not currently providing IMS at this time. 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.

No deficiencies observed in the areas inspected during today's inspection. This report was reviewed and discussed with the facility representative at the time of the inspection.

A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
NOTICE OF SITE VISIT FORM POSTED TO PARENT'S BOARD FOR 30 DAYS.

To order forms, etc. visit our website at www.ccld.ca.gov

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020

LIC809 (FAS) - (06/04)

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