340312840-5-4-2022-03-CC-GSIH-CE4UQN-20220504154724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340312840
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:47:36 PM

Document Has Been Signed on 05/04/2022 03:47 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 - SEQUOIA		FACILITY NUMBER:	340312840
ADMINISTRATOR:	MICHELE CARTHEN		FACILITY TYPE:	840
ADDRESS:	3333 ROSEMONT DRIVE		TELEPHONE:	(916) 277-6105
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95826
CAPACITY:	100	CENSUS: 9	DATE:	05/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Samantha Hui		TIME COMPLETED:	03:30 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 representative, Samantha Hui, for an unannounced annual inspection. Purpose of the inspection was explained. The facility operates at school site. Upon LPA’s arrival, there were ten children in care with three staff members. Facility is operating with in the capacity and in compliance with staff child ratio on this day. Facility operate day care from Monday to Friday between 7 AM to 6 PM. During inspection, LPA inspected the day care classrooms. Facility has multiple smoke detectors and fire extinguishers at the site. Facility has carbon monoxide detector, first aid supplies 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. Facility has age appropriate furniture. Furniture is steady and in good repair. All of the unused electrical outlets have child protective covers installed. Facility has gender separated toilets. All toilets, hand washing facilities are in working condition with proper sanitation in place. Facility has drinking water available for children. Play yard is free of hazards. Facility has age appropriate play structures. All of the play structures are steady, in good repair and free of any loose parts. There is sufficient amount of wood chips under the play structures to prevent any fall injuries. Play yard has trees to provide shaded area for children. LPA reviewed the facility records. LPA observed that facility has sign in / out record with full legal signatures. LPA reviewed ten 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. One of the present staff members has record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers. LPA reminded the facility representative that fire drill must be done at least once a month and must be logged. Per facility representative, last drill was conducted in April 2022 and LPA observed facility has log in place. 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: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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 - SEQUOIA	FACILITY NUMBER: 340312840
	VISIT DATE: 05/04/2022

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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 review AB 1207 with the facility representative and reminded 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 current staff has completed the training and certificates are on file.

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: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

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