313623712-10-15-2020-03-CC-SDLA-BUEPPQ-20201015112955

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313623712
Report Date: 10/15/2020
Date Signed: 10/15/2020 11:30:05 AM

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 - RIEGO CREEK		FACILITY NUMBER:	313623712
ADMINISTRATOR:	EATON, MEGAN		FACILITY TYPE:	840
ADDRESS:	3255 PRUETT DRIVE		TELEPHONE:	(916) 774-5506
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	90	CENSUS: 0	DATE:	10/15/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Christie Dentry		TIME COMPLETED:	10:30 AM

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	Application Specialist (AS) Seychelle De Luca and Licensing Program Analyst (LPA) Katrina Owens met with Recreation and Libraries Supervisor Christie Dentry for the purpose of an announced prelicensing tele-inspection (due to COVID-19). The program requests a school-age license to serve 90 school-age children enrolled in kindergarten and above. The program will operate Monday through Friday from 6:30 AM to 6:00 PM. AS received the school’s fire clearance on 9/17/2020. The facility is located at Riego Creek Elementary School. Supervisor acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. AS and LPA discussed the forms that must be in each child's and each staff member's file. The facility will be providing morning and afternoon snack and children will bring their own lunches. INDOOR ACTIVITY SPACE: Supervisor requests to use two classrooms located in the multipurpose room and one portable: Classroom 1 and Classroom 2. AS and LPA observed a sufficient amount of equipment, tables, and chairs. There is a first aid kit and medications will be stored in the classroom in an inaccessible area. AS and LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Supervisor stated there are no poisons or firearms on the premises. AS and LPA observed water fountains in the classrooms. Supervisor stated children will bring water bottles to use during COVID-19. AS and LPA observed a paper sign-in/sign-out system. Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

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 - RIEGO CREEK	FACILITY NUMBER: 313623712
	VISIT DATE: 10/15/2020

NARRATIVE

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Prior to today’s tele-inspection, Supervisor sent AS a signed letter from Superintendent. The letter states that the classrooms in the portable are of sufficient size to accommodate 60 school-age children. Supervisor is working on obtaining an updated letter to permit use of the multipurpose room. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, AS and LPA did not take measurements. The children will use the school’s restrooms, and a separate private restroom for the staff. Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. There is a climbing structure that Supervisor states is anchored into the ground. AS and LPA observed a safety label that reads the climbing structure is intended for children from ages 5-12 years old. AS and LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees.

The facility's Plan of Operation is located in the Administrative file. Incidental Medical Services (IMS) policy was discussed. 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.

AS and LPA discussed the following: supervision; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS and LPA discussed with Supervisor any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

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 - RIEGO CREEK	FACILITY NUMBER: 313623712
	VISIT DATE: 10/15/2020

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This facility evaluation report was reviewed and discussed with Supervisor. Supervisor was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

AS emailed a copy of the 809 to Supervisor. Supervisor acknowledges that she must read the report and send AS an email stating she received, read, and understands today’s report. AS also provided LIC 311A and Effects of Lead Exposure brochure.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:

1. Submit a waiver request for all criminal record clearances to be associated to Adventure Club - Fiddyment Farm #313617646.

2. Submit updated letter from Superintendent that states the rooms are of sufficient size to meet the requested capacity of 90 school-age children.

3. Verification of a functional carbon monoxide detector in the classrooms and multipurpose room.

4. Proof 90 hooks have been installed in the two classrooms.

5. A final review of the file by Licensing Program Manager (LPM) Keven Peters.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2020

LIC809 (FAS) - (06/04)

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