340311928-8-8-2019-03-CC-MLOR-BEUTH8-20190808144418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340311928
Report Date: 08/08/2019
Date Signed: 08/08/2019 02:44:26 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:	4TH R - GENEVIEVE DIDION		FACILITY NUMBER:	340311928
ADMINISTRATOR:	NGUYEN, LYNN		FACILITY TYPE:	840
ADDRESS:	6490 HARMON DR.		TELEPHONE:	(916) 433-6675
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	100	CENSUS: 71	DATE:	08/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Laurel Rieger		TIME COMPLETED:	03:00 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Mai Lor and Seychelle De Luca met with Program Developer Laurel Rieger for the purpose of an unannounced annual random inspection. Program had requested to increase capacity from 100 to 150 school-age children. LPA Lor obtained the fire clearance prior to today's inspection. LPAs measured classrooms 1, 3 and multipurpose room. The total classroom space contains a total of 5307.68 square feet, which will accommodate Applicant's request for 150 children. The Program Developer was reminded never to exceed the conditions, limitations, and capacity specified on the license. Census included 71 school-age children supervised by 8 staff members. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPAs toured all activity and classroom spaces, restrooms, food service, and outdoor play areas. Medications are stored appropriately and are inaccessible to children. Program Developer stated that poisons are locked in a cabinet. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts. The areas around or under climbing equipment are cushioned with bark to absorb the fall. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers. During the summer, program provides morning and afternoon snacks; and children bring their own lunches. Menus were posted and drinking water was readily available to children both indoors and outdoors. LPA observed full legal signatures while reviewing the sign-in and sign-out sheet as required for school-age component.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

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: 4TH R - GENEVIEVE DIDION	FACILITY NUMBER: 340311928
	VISIT DATE: 08/08/2019

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A random sample of staff and children's files were reviewed. Each child's file contained an emergency card and a consent for medical treatment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 03/2020). All staff currently employed with the facility have a criminal record clearance, health screening report, and documentation of the educational background, training, and/or experience. A current fire drill log was observed with the last one conducted on June 11, 2019.

There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector. LPA reviewed the Department's inspection authority and discussed with Program Developer any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.

The facility's Plan of Operation is located in the facility file. Incidental Medical Services (IMS) policy was discussed. IMS is provided by this facility. 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 athttp://www.ada.gov/childqanda.htm.

This facility evaluation report was reviewed and discussed with Program Developer. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Program Developer was encouraged to the visit the department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. LPA provided and discussed Effects of Lead Exposure brochure.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

Pending approval of capacity increase:

1. LPM Roxana Saravia's final file review.
2. Updated LIC 308, LIC 500, LIC 610 to reflect current administration.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019

LIC809 (FAS) - (06/04)

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