310317468-2-25-2022-03-CC-KOWS-CBYRAD-20220225115058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 310317468
Report Date: 02/25/2022
Date Signed: 02/25/2022 11:51:04 AM

Document Has Been Signed on 02/25/2022 11:51 AM - It Cannot Be Edited

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:	02/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Stephanie Taylor-Youth Development Program Coordinator		TIME COMPLETED:	12:00 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 and Blesi. LPA Owens and Blesi met with Stephanie Taylor, Youth Development Program Coordinator. LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. No children were present at time of 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. Wood chips is being used as cushioning around the climbing equipment. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Children are escorted to the school restrooms. 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 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. Stephanie Taylor 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. Continued on next page.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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: 02/25/2022

NARRATIVE

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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. Operating hours are Monday thru Friday; 6:30 AM to 6:00 PM.

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 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. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

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.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

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