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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340318012
Report Date: 11/21/2019
Date Signed: 11/21/2019 11:44:12 AM

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:SETA - ALDER GROVE INFANT/TODDLER CTRFACILITY NUMBER:
340318012
ADMINISTRATOR:RODRIGUEZ, JENNAFACILITY TYPE:
850
ADDRESS:2640 A MUIR WAYTELEPHONE:
(916) 322-7068
CITY:SACRAMENTOSTATE: CAZIP CODE:
95818
CAPACITY:20CENSUS: 12DATE:
11/21/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Nikki GrigaitisTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA), Goodell met with director Nikki Grigaitis for an unannounced Annual Inspection. The facility’s hours of operation are Monday- Friday, 8am- 4pm. LPA conducted a census of 12 present with 5 staff and director. All individuals present have obtained fingerprint clearance through Community Care Licensing. LPA observed required postings: Facility License (LIC 203A), Personal Rights (LIC9040), Emergency Disaster Plan (LIC610), Earthquake Preparedness Checklist (LIC9148), and Parent’s Rights Poster (PUB393).

LPA toured all activity/classroom areas, children’s furniture, equipment, food service area, outdoor area and restrooms. LPA reviewed the electronic sign/in-sign/out sheet. Facility provides breakfast, snack and lunch. LPA observed a current menu and activity posted in the entrance of the facility. LPA observed cleaning compounds are stored inaccessible to children. LPA observed the changing tables’ meet Title 22 requirements and are located near a sink. LPA observed fire extinguisher 2A10BC, smoke and carbon monoxide detector. LPA observed fire drill log maintained. LPA reviewed children and staff files. At least one staff member present has current CPR/1st Aide which expires on 5/4/2020. LPA provided the Community Care Licensing website www.ccld.ca.gov, so the director can obtain updated licensing information, new regulations, self-assessment guides and access forms. LPA advised the director of their responsibility to stay current in regards to new regulations.

No Title 22 deficiencies cited. LPA reviewed report with the director and provided copies. Notice of Site Visit issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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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