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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614095
Report Date: 03/05/2025
Date Signed: 03/05/2025 03:28:11 PM

Document Has Been Signed on 03/05/2025 03:28 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 - HERONFACILITY NUMBER:
343614095
ADMINISTRATOR/
DIRECTOR:
CARRIER, YVONNEFACILITY TYPE:
840
ADDRESS:5151 BANFIELD DRIVETELEPHONE:
(916) 566-1520
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 107DATE:
03/05/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Nicholas EblingTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On Wednesday, 5 March, 2025 at approximately 2:15 PM, Licensing Program Analyst (LPA) Fabian Schwartz met with Program Coordinator Nicholas Ebling for the purpose of an unannounced annual random inspection. LPA observed care and supervision of 107 School aged children by 11 staff which included the Program Coordinator. All persons requiring criminal background checks have been cleared through Guardian system. The license has a maximum capacity of 150. The facility hours of operation are Monday through Friday 7:00 AM to 8:00 AM and 2:00 PM to 6:00 PM.

LPA toured the classrooms, restrooms, outdoor play areas, gym, and occasional use classrooms. Facility operates in Rooms 1, 2, G2, G7, and occasionally the Gymnasium. Teacher stated there are no firearms on the premises. Toxic and hazardous items are inaccessible to children and are stored locked cabinet. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts and the ground below the play structures is sufficiently padded with rubberized substrate. Restrooms are in sanitary condition with functioning toilets. The floors were clean throughout the facility. Medications are stored out of children’s reach and labeled according to regulation.

LPA observed that solid waste containers were covered. Drinking water was readily available to children both indoors and outdoors. LPA observed an electronic sign in and out device near the entrance.

All present staff files were reviewed. LPA observed a current Mandated Reporter certificate for every staff member and a current CPR and First Aid certificate which will expire 10 January 2026. LPA observed completed facility roster and fire drill log last updated 23 January 2025.

Report continues on LIC809-C…

Amanda BlesiTELEPHONE: (916) 263-5721
Fabian SchwartzTELEPHONE: (916) 263-5744
DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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 - HERON
FACILITY NUMBER: 343614095
VISIT DATE: 03/05/2025
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LPA reviewed 3 children’s files and observed them to be complete. LPA observed first aid equipment, functioning smoke and carbon monoxide detectors which are hardwired into the classroom fire alarm system, and fully charged fire extinguishers meeting regulation. Required documents were posted.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

This facility does provide Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care- centers/.

Based on today’s inspection, no deficiencies are being cited for facility. Exit interview was conducted and report was reviewed with the Acting Site Supervisor. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Amanda BlesiTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Fabian SchwartzTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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