340310500-11-9-2023-03-CC-DVAG-CXETX2-20231109140622

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340310500
Report Date: 11/09/2023
Date Signed: 11/09/2023 02:06:28 PM

Document Has Been Signed on 11/09/2023 02:06 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:	4TH R - CROCKER RIVERSIDE		FACILITY NUMBER:	340310500
ADMINISTRATOR:	DEEANN ESCALANTE		FACILITY TYPE:	840
ADDRESS:	2970 RIVERSIDE BLVD		TELEPHONE:	(916) 264-8385
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY:	150	CENSUS: 17	DATE:	11/09/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Amy Brown		TIME COMPLETED:	01:30 PM

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On 11/9/2023 at 9:00 a.m., LPA Pa Dao Vang met with Facility Representative, Amy Brown, for the purpose of an unannounced 3 year required inspection. There were 17 children supervised by 4 staffs at 9:00a.m. for the morning class. The morning class leaves and transitioned out of the classroom at 11:30a.m. At the same time, new group of 26 children transitioned into the classroom eating lunch and supervised by 4 staffs for the afternoon class. LPA toured the classroom and shared spaced of the auditorium and outdoor play yard. All individuals subject to criminal background review have obtained clearance.

A health and safety inspection was conducted in the classrooms, restrooms, and outdoor play areas. LPAs observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, required publications, menus, and daily schedules. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. There are medications stored at facility in a locked cabinet. Furniture and equipment are in good condition, and toileting facilities are in sanitary, and operating condition. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. LPAs observed working smoke alarm, carbon monoxide, and a fire extinguisher in every room with 3A-10-BC. LPA observed that children are signed in and out of the facility using a digital application.

Children have access to water indoors and outdoors using their water bottles that are transported with children, during transitions. Playground equipment and surfaces are free of loose or sharp parts. LPAs observed sufficient cushioning under the play structure. Outdoor shade is provided by canopies and trees. There are no firearms or bodies of water on the premises. Facility representative stated there are no poisons on the premises.

Continue report on LIC809-C...

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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: 4TH R - CROCKER RIVERSIDE	FACILITY NUMBER: 340310500
	VISIT DATE: 11/09/2023

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LPAs reviewed staff files. At least one staff member present today has current Pediatric CPR and First Aid certification in which will expire on 09/10/2025. LPAs observed required documentation, educational background, training, and/or experience. Upon review, facility representative have current mandated reporter training in which will expire on 05/24/2025. LPAs advised AB 1207 Mandated Reporter training must be renewed every two years and can be renewed at www.mandatedreporterca.com.

Facility have a record of conducting fire drills at least every six months with the last log on 09/29/2023.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for

drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Continue on report on LIC809-C...

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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: 4TH R - CROCKER RIVERSIDE	FACILITY NUMBER: 340310500
	VISIT DATE: 11/09/2023

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative Amy Brown.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Dao Vang	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

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