343623875-3-18-2021-03-CC-SDLA-BZ8T8K-20210318143028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623875
Report Date: 03/18/2021
Date Signed: 03/18/2021 02:30:39 PM

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 - PASO VERDE		FACILITY NUMBER:	343623875
ADMINISTRATOR:	DJALILI, MARIA		FACILITY TYPE:	840
ADDRESS:	3883 DEL PASO ROAD		TELEPHONE:	(916) 566-4496
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95834
CAPACITY:	150	CENSUS: 0	DATE:	03/18/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Joyce Wenger-Johnson		TIME COMPLETED:	11:30 AM

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	Application Specialist (AS) Seychelle De Luca and Licensing Program Analyst (LPA) Rosie Pitts met with Licensee Representative Joyce Wenger-Johnson for the purpose of an announced prelicensing change of location tele-inspection (due to COVID-19). The facility's current license number is 343621995. Licensee Representative requests a school-age license to serve 150 school-age children enrolled in kindergarten and above. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. Licensee Representative stated that during COVID, the facility will operate after school, only. Licensee Representative requested a waiver for all employee clearances to be associated to 4th R - Crocker Riverside #340310500, and AS granted the waiver. The facility is located at Paso Verde School. Licensee Representative acknowledges that the following documents must be posted at all times: License, Central Fingerprint Waiver, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. AS and LPA discussed the forms that must be in each child's and each staff member's file. The facility will be providing afternoon snack. INDOOR ACTIVITY SPACE: Licensee Representative requests to use classrooms A6, B8, C4, and Multipurpose Room. Licensee Representative sent AS photos of the currently licensed classrooms which have most of the furniture and equipment. Licensee Representative stated these will be moved over on Saturday. Licensee Representative stated there will be first aid kits in all classrooms. Licensee Representative stated medications will be stored in the office area of A6. Licensee Representative stated cleaning disinfectants will be appropriately stored and inaccessible to children in A6. Licensee Representative stated there are no poisons or firearms on the premises. AS observed water fountains and water bottle refill stations. Licensee Representative stated children will bring water bottles and the facility will have extras on site. Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

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 - PASO VERDE	FACILITY NUMBER: 343623875
	VISIT DATE: 03/18/2021

NARRATIVE

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Licensee Representative stated the facility will use a paper sign-in/sign-out system. Licensee Representative stated there are functional carbon monoxide detectors in each building that are hardwired into the fire alarm system and maintained by the school.

Prior to today’s tele-inspection, Licensee Representative sent AS a signed letter from Deputy Superintendent. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, AS did not take measurements. The children will use the school’s restrooms, and there is a separate private restroom for the staff. Children who become ill during the day will be isolated in the office and will use the restroom in the nurse's station, if necessary.

OUTDOOR ACTIVITY SPACE:
There are two outdoor areas on the property. There are no bodies of water on the premises. There are shaded areas supplied by shade structures. Licensee Representative stated children will bring their water bottles outside.

The facility's Plan of Operation is located in the Administrative file. Incidental Medical Services and a Plan of Operation is located in the facility file. Incidental Medical Services (IMS) policy was discussed. 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.

AS discussed the following: supervision; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS discussed with Licensee Representative 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.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

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 - PASO VERDE	FACILITY NUMBER: 343623875
	VISIT DATE: 03/18/2021

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This facility evaluation report was reviewed and discussed with Licensee Representative. Licensee Representative was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

AS emailed a copy of the 809 to Licensee Representative. Licensee Representative understands she must read the report and send AS an email stating she received, read, and understands today’s report. AS also provided LIC311A, Effects of Lead Exposure brochure, and Healthy Schools Act survey.

Director is enrolled for the EMSA Preventative Health and Safety course that will take place 4/17/2021.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A PROVISIONAL LICENSE:

1. Fire clearance.

SUPERVISOR'S NAME: Roxana Saravia	TELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De Luca	TELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

LIC809 (FAS) - (06/04)

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