340311930-5-10-2019-03-CC-MBED-BC2R46-20190510124100

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340311930
Report Date: 05/10/2019
Date Signed: 05/10/2019 12:41:16 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 - O.W. ERLEWINE		FACILITY NUMBER:	340311930
ADMINISTRATOR:	SUZANNE CONTRERAS		FACILITY TYPE:	840
ADDRESS:	2441 STANSBERRY WAY		TELEPHONE:	(916) 277-6104
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95826
CAPACITY:	70	CENSUS: 9	DATE:	05/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Erin Quinonez		TIME COMPLETED:	01:00 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Marea Behvand and Joleen Kenny met with Program Coordinator Erin Quinonez for the purpose of an unannounced annual random inspection. Program Coordinator was reminded never to exceed the conditions, limitations and capacity specified on the license. Census included 9 school-age children supervised by three staff members. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPA toured all activity and classroom spaces, restrooms, food service, and outdoor play areas. Medications are stored appropriately and are inaccessible to children. Program Coordinator stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. The playground area surfaces are free of loose or sharp parts. 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. Program provides afternoon snack. 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.

Staff and children's records 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. 08/25/2020). All staff currently employed with the facility have a criminal record clearance through the City of Sacramento, health screening report, and documentation of the educational background, training, and/or experience. 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 Coordinator 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.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea Behvand	TELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

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 - O.W. ERLEWINE	FACILITY NUMBER: 340311930
	VISIT DATE: 05/10/2019

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The Plan of Operation is available 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 Coordinator. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. Program Coordinator was encouraged to 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 the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Program Coordinator can request to be added to the distribution list to receive Quarterly Updates.

An exit interview was conducted and no deficiencies were observed or cited during today's inspection.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea Behvand	TELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

LIC809 (FAS) - (06/04)

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