343606960-8-11-2023-03-CC-AMAT-CULU57-20230811151617

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343606960
Report Date: 08/11/2023
Date Signed: 08/11/2023 03:16:28 PM

Document Has Been Signed on 08/11/2023 03:16 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	4TH R - TWO RIVERS		FACILITY NUMBER:	343606960
ADMINISTRATOR:	JEANINNIE SELF		FACILITY TYPE:	840
ADDRESS:	3201 WEST RIVER DRIVE		TELEPHONE:	(916) 277-3849
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95833
CAPACITY:	100	CENSUS: 72	DATE:	08/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tammy O'Callaghan		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	On Friday August 11th, 2023, Licensing Program Analyst (LPA) Arianna Manabat met with Director Tammy O'Callaghan for an unannounced annual inspection. At 1:00 PM, LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Census included 72 children in care with five staff. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license (capacity of 100). Facility hours of operation are Monday through Friday 7:00 AM - 7:35 AM (Morning Time) to 1:55PM - 6:00PM for 1ST-5TH GRAGE and 1:38 PM-6:00PM for TK- KINDER. Minimum days 12:18pm - 6:00pm for TK-Kinder and 12:35pm - 6:00PM for 1st-5th grade. Facility 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. Classrooms all appeared clean including the carpets and floor. Chemicals and cleaning materials were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Drinking water was readily available to children both indoors and outdoors. Playground provided shade. Bathrooms were clean and all sinks and toilets were in operating condition. There are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. Menus were posted for AM and PM snack. LPA observed the appropriate postings were visible to parents. The facility is equipped with First Aid equipment. LPA observed parents are signing their children in and out of the center. *Continued on LIC 809-C.....*

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Arianna Manabat	TELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: 4TH R - TWO RIVERS	FACILITY NUMBER: 343606960
	VISIT DATE: 08/11/2023

NARRATIVE

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... Continued from LIC 809......

LPA Manabat reviewed staff files and transcripts and observed all staff being utilized as teachers were qualified. LPA Manabat observed current Mandated Reporter certificates and proof of immunization for the staff. At least one staff had a current Pediatric CPR and First Aid certification.

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

No citations were issued based on today’s inspection. Exit interview was conducted and report was reviewed with the Facility Representative. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR NAME: Arianna Manabat	TELEPHONE: (279) 200-2886
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC809 (FAS) - (06/04)

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