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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620603
Report Date: 01/02/2020
Date Signed: 01/02/2020 12:00:18 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:CLUB ROCKLIN CDI - RUHKALA (SA)FACILITY NUMBER:
313620603
ADMINISTRATOR:MARTINEZ, STEPHANIEFACILITY TYPE:
840
ADDRESS:6530 TURNSTONE WAYTELEPHONE:
(916) 632-6560
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:88CENSUS: 17DATE:
01/02/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Janet RowettTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Jeremey McClain met with Lead Teacher Janet Rowett and Program Director Kate Stauffer for an unannounced Case Management Inspection. The purpose of today’s inspection was to follow up on the incident the facility reported via fax on 12/17/2019.

Upon arrival, LPA observed 17 school age children supervised by three staff members.

It was reported that on 12/10/2019, two children collided while playing outside on the playground. One child suffered a broken nose as a result of the collision. The child has since returned to care at the facility. LPA interviewed the teacher that was present during the incident. The child was not available for interview today.

LPA determined that there were no Title 22 deficiencies related to the incident.

This report was reviewed with the Head teacher and Program Director. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2020
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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