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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343605744
Report Date: 07/25/2024
Date Signed: 07/25/2024 10:42:28 AM

Document Has Been Signed on 07/25/2024 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:4TH R - NATOMAS PARKFACILITY NUMBER:
343605744
ADMINISTRATOR/
DIRECTOR:		TAMSY, TARAFACILITY TYPE:
840
ADDRESS:4700 CREST DRIVETELEPHONE:
(916) 264-1064
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 36DATE:
07/25/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Tara TamsyTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 7/25/2023 at approximately 10:30am, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Arianna Manabat met with Program Coordinator Tara Tamsy for the purpose of an unannounced change of capacity case management inspection. The Licensee requests a total of 150 school-age children ages Enrolled in Transitional Kindergarten to 5th grade. The fire clearance was received and granted on 04/24/2024. The program operates Monday through Friday 7:00 AM to 6:00 PM.

INDOOR ACTIVITY SPACE:
The program is located on an elementary school site and utilize five portables, #701, #702, #205, #1, #2, and the auxilary room to operate. During today's visit, LPAs observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and physical plant requirements for school-age programs. CAB LPA did not measure the indoor space as per Title 22 regulation Indoor Activity Space for School-Age Children 101538.3(c) which states that School-age child care programs that meet the requirements of Health and Safety Code Section 1596.806 are exempt from square-footage requirements for indoor activity space.

OUTDOOR ACTIVITY SPACE:
During today's visit LPA Manabat observed a sufficient amount of equipment and toys available for use. LPA Manabat did not measure the outdoor space as per Title 22 regulation 101538.2 (c) for Outdoor Activity Space for School-Age Children states that School-age child care programs that meet the requirements of Health and Safety Code Section 1596.806 are exempt from square-footage requirements for outdoor activity space. The children do utilize all outdoor play areas that are available on the school site except for the kindergarten playground.

Facility Representative stated there are no firearms, weapons, or bodies of water on the facility premises. There are shaded areas supplied by trees and overhangs

Report continues on LIC809-C....
NAME OF LICENSING PROGRAM MANAGER: Mai Lor
NAME OF LICENSING PROGRAM ANALYST: Arianna Manabat
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: 4TH R - NATOMAS PARK
FACILITY NUMBER: 343605744
VISIT DATE: 07/25/2024
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Licensee Representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Prior to issuing a license, the following conditions must be submitted:

1. Pending Licensing Program Manager's final review.
Exit interview conducted and report was reviewed with the Licensee Representative.
NAME OF LICENSING PROGRAM MANAGER: Mai Lor
NAME OF LICENSING PROGRAM ANALYST: Arianna Manabat
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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