340311930-2-7-2022-03-CC-GSIH-CBERS4-20220207121607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340311930
Report Date: 02/07/2022
Date Signed: 02/07/2022 12:16:17 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: 0	DATE:	02/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Emma Nunez		TIME COMPLETED:	12:30 PM

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	Licensing Program Analyst (LPA) Gagandeep Singh met with facility representatives, Emma Nunez and Cheng Thao, for an annual inspection. Purpose of the inspection was explained. This facility operates at a school site in Portable 1 and 2 from Monday to Friday between 7 AM to 6 PM. Portable 2 was known and licensed as ‘Miller brock’ classroom. Upon LPA’s arrival, there were no children in the classroom. With facility representative, LPA inspected the day care areas: Classrooms, Bathroom and Play yard. Facility has smoke detector, carbon monoxide detector, multiple fully charged fire extinguishers, fire pull alarms 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 has child protective locks installed. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. All toilets, hand washing facilities are in working condition with proper sanitation in place. Facility has drinking water available for children. Facility provides the snack and school provides the meal. All the food is stored in properly manner and has lid to avoid any contamination. There is food allergy list posted on the refrigerator. Play yard is free of hazards. All of the play structures are steady, in good repair and free of any loose parts. During inspection, LPA reviewed the facility records. LPA observed that facility has all of the required documents posted and are visible for the public. Per facility representative, the school conducts the fire drills once a month. The facility staff has CPR training certificate valid until January 21, 2024. 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 certificate in the facility records. See next page for continuation ...................

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022

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: 02/07/2022

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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

LPA encourages the director to frequently visit our 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 represenative. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022

LIC809 (FAS) - (06/04)

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