<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553615368
Report Date: 08/18/2022
Date Signed: 08/18/2022 11:30:49 AM


Document Has Been Signed on 08/18/2022 11:30 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:TWAIN HARTE PM CLUBFACILITY NUMBER:
553615368
ADMINISTRATOR:RICE, SAMANTHAFACILITY TYPE:
840
ADDRESS:18815 MANZANITA DRIVETELEPHONE:
(209) 768-8005
CITY:TWAIN HARTESTATE: CAZIP CODE:
95383
CAPACITY:45CENSUS: 0DATE:
08/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Samantha RiceTIME 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) Alecia Sifuentes met with Director, Samantha Rice for the purpose of an announced case management inspection. Licensee requests a change of capacity to serve 100 school-age children from kindergarten and above. The program operates Monday through Friday from 12:00 p.m. to 5:30 p.m. The elementary school’s annual passing fire inspection report was received on 8/15/2022.

A health and safety inspection was conducted in all areas accessible to children. Superintendent/Principal letter is on file allowing the program to utilize the cafeteria. 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 staff.

Licensee 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 on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Samantha Rice.

Effective today, 8/18/2022, AS will approve the change of capacity.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022
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 1