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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343610711
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:10:42 PM


Document Has Been Signed on 04/21/2022 03:10 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 - REGENCY PARKFACILITY NUMBER:
343610711
ADMINISTRATOR:WILES, CARRIEFACILITY TYPE:
840
ADDRESS:5901 BRIDGECROSS DR.TELEPHONE:
(916) 566-3636
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:100CENSUS: 0DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Cameron VansoestTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Michelle Pascual met with Facility Representative Cameron Vansoest, for the purpose of an unannounced annual random inspection. Upon arrival, there were no children present. All staff had criminal record clearance. The facility is open Monday-Friday from 7:00 am to 6:00 pm. Snacks are provided for children.
LPA toured the facility inside and out for a health and safety inspection. Physical plant- There are no firearms or bodies of water on the premises. The facility appeared orderly and suitable for children. Cleaning supplies and hazardous items were inaccessible to children. Medication is stored in a safe place inaccessible to children in care. Outdoor activity space and equipment was in good repair. Uncontaminated drinking water is available both indoors and outdoors. Facility has a current fire/disaster drill log. LPA observed a first aid kit. LPA observed that solid waste storage vessels/bins had tight fitting covers on and in good repair. All toilets and hand washing facility is safe and sanitary operating condition. Facility has license, parent’s rights, emergency evacuation, and car seat safety posted. Facility Administration- The department has inspection authority. LPA observed that at least one staff member has current CPR and Pediatric First Aid (exp 01/24). Mandatory Reporter expires (12/23). LPA reviewed the Departments inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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 - REGENCY PARK
FACILITY NUMBER: 343610711
VISIT DATE: 04/21/2022
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Evaluation of care and supervision- No children present at time. LPA did verify sign in/sign out. FACILITY RECORDS REVIEW- children’s records included emergency contact. Staff personnel record contained documentation of the educational backgrounds, training, and or experience.

Incidental Medical Services (IMS) policy was discussed and is being provided. 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.

The facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for a period of 30 days for parental review. Director was encouraged to the visit the department’s website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. Their signature on this form acknowledges receipt of this form.



Based upon today’s inspection, no Title 22 deficiency was cited.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC809 (FAS) - (06/04)
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