343604770-9-8-2022-03-CC-GSIH-CJ3SXQ-20220908141620

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343604770
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:16:30 PM

Document Has Been Signed on 09/08/2022 02:16 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 - GOLDEN EMPIRE		FACILITY NUMBER:	343604770
ADMINISTRATOR:	JOYCE WENGER-JOHNSON		FACILITY TYPE:	840
ADDRESS:	9045 CANBERRA DRIVE		TELEPHONE:	(916) 227-6174
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95826
CAPACITY:	70	CENSUS: 6	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Carmen Gutierrez		TIME COMPLETED:	02:30 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 program coordinator, Carmen Gutierrez, for an annual inspection. Purpose of the inspection was explained. Facility operates at school site in Portable from Monday to Friday between 12 Noon to 6 PM. Upon LPA's arrival, there were six children with two staff members. Facility is operating with in the capacity and in compliance with staff child ratio on this day. During inspection, LPA inspected the day care classroom and play yard. LPA observed facility has smoke detector, carbon monoxide detector, fully charged fire extinguisher and working telephone at the site. Facility also has fire pull alarm installed. 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. 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. During inspection, LPA reviewed the facility records. Facility has license and all of the other required documents posted next to the entrance door and are visible for public. Facility has conducted the fire drill on May 17, 2022 and has next drill will be conducted with the school. LPA reviewed random children's and all staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. LPA observed program coordinator has a valid CPR training certificate on file. LPA reviewed the educational qualification of all the teachers. There are menus posted at least one week in advance and are visible to the child's authorized representative. LPA reminded the facility that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. See next page for continuation .................

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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 - GOLDEN EMPIRE	FACILITY NUMBER: 343604770
	VISIT DATE: 09/08/2022

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All Child Care Centers (CCCs) that are located in buildings constructed before January 1, 2010 must have their drinking water tested for lead and post the results by January 1, 2023 and every 5 years after the date of the initial test. For a license issued on or after July 1, 2022, the CCC must have its water tested and post the results within 180 days of licensure.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 facility representative 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 program coordinator. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Natalie Dunaway	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

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