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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313610190
Report Date: 08/21/2023
Date Signed: 08/21/2023 04:08:12 PM


Document Has Been Signed on 08/21/2023 04:08 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ADVENTURE CLUB - THOMAS JEFFERSONFACILITY NUMBER:
313610190
ADMINISTRATOR:BEESON, SARAHFACILITY TYPE:
840
ADDRESS:750 CENTRAL PARK DRIVETELEPHONE:
(916) 771-4267
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:90CENSUS: 0DATE:
08/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ashley Fikes - Child Care Program LeaderTIME COMPLETED:
01:30 PM
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An unannounced annual/random inspection is made today by Licensing Program Analyst Owens. LPA Owens met with Ashley Fikes, Child Care Program Leader. LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. No day care children were present during inspection. The facility is located on Thomas Jefferson Elementary school grounds.

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. Children's toilets, hand washing facilities are sanitary; children use the school restrooms. Rooms are safe and clean. Carbon Monoxide detector is on the premises. 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 PM snacks. 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. Facility representative, 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. Staff subject to a criminal record clearance or exemption are associated to the facility. Continued on next page.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2023
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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ADVENTURE CLUB - THOMAS JEFFERSON
FACILITY NUMBER: 313610190
VISIT DATE: 08/21/2023
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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; 12:30 PM to 6:00 PM.
LPA observed proof that all staff 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 verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Testing was completed on 12/9/2022. Facility understands that the lead testing must be conducted every five years from initial testing.



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 medication were observed at the facility at time of inspection. No children currently on medication.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Continued on next page.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ADVENTURE CLUB - THOMAS JEFFERSON
FACILITY NUMBER: 313610190
VISIT DATE: 08/21/2023
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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.
A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: (916) 879-1175
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3