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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340311929
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:26:37 PM


Document Has Been Signed on 03/09/2023 03:26 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:4TH R - HUBURT BANCROFTFACILITY NUMBER:
340311929
ADMINISTRATOR:VERONICA GRIFFITHFACILITY TYPE:
840
ADDRESS:2929 BELMARTELEPHONE:
(916) 277-6100
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY:70CENSUS: 31DATE:
03/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Brooke MajorTIME COMPLETED:
04:00 PM
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On March 9th, 2023, at 1:30 PM, Licensing Program Analysts (LPA) Gagandeep Singh and David Nguyen met with Program Coordinator, Brooke Major, for an unannounced annual inspection. Purpose of the inspection was explained. Upon LPA’s arrival, there were 31 children with four staff members. Facility is operating with in the capacity and in compliance with staff child ratio on this day. Facility operates day care from Monday to Friday between 7 AM to 8:30 AM and 11:30 AM to 6 PM. The facility is licensed to operate from portable room # 1, # 2 and Multipurpose room. The facility is using the bathroom from the school.

During today’s inspection, LPA inspected the day care rooms. There are no pools, spas or other bodies of water at the facility. Facility has smoke detector, carbon monoxide detector, fire pull alarms, fully charged fire extinguishers and working telephone at the site. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Cabinets with chemicals have child protective locks installed. Facility has age-appropriate furniture. Furniture is steady and in good repair. All toilets, hand washing facilities are in working condition with proper sanitation in place. All storage containers for solid waste and in good repair and have proper lid on top. Facility has drinking water available for children. Play yard is free of hazards.

LPA reviewed the facility records. LPA observed that facility is using electronic sign in / out. Facility has well maintained roster available on site. LPA reviewed random children's and all present staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. Present staff member has record of valid CPR card in file. LPA observed the fire drill log in place. Per log, last drill was conducted on December 19, 2022.
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SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) -91-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2023
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: 4TH R - HUBURT BANCROFT
FACILITY NUMBER: 340311929
VISIT DATE: 03/09/2023
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This facility provides no Incidental Medical Services – IMS at this time. LPA reviewed storage of first aid and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

LPA reminded the facility representative that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates of all present staff.



LPA encourages the facility to frequently visit website at www.ccld.ca.gov for licensing regulations and new updates. Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

No deficiencies are cited today. The copy of this report is reviewed and provided to the facility representative. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Chayntel HunterTELEPHONE: (916) -91-8620
LICENSING EVALUATOR NAME: David NguyenTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
LIC809 (FAS) - (06/04)
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