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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340311930
Report Date: 01/17/2023
Date Signed: 01/17/2023 12:48:04 PM


Document Has Been Signed on 01/17/2023 12:48 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:4TH R - O.W. ERLEWINEFACILITY NUMBER:
340311930
ADMINISTRATOR:SUZANNE CONTRERASFACILITY TYPE:
840
ADDRESS:2441 STANSBERRY WAYTELEPHONE:
(916) 277-6104
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY:70CENSUS: 2DATE:
01/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Richard PetiteTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with facility representatives, Richard Petite, 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.

During the inspection, 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. All toilets, hand washing facilities are in working condition with proper sanitation in place. Facility has age appropriate furniture. Furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. Facility has drinking water with water dispenser available for children. 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 11, 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. LPA reviewed random children's records and observed facility has record of emergency contact information of each child.

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SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: 4TH R - O.W. ERLEWINE
FACILITY NUMBER: 340311930
VISIT DATE: 01/17/2023
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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 representative. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
LIC809 (FAS) - (06/04)
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