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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570308535
Report Date: 05/05/2023
Date Signed: 05/05/2023 12:53:15 PM


Document Has Been Signed on 05/05/2023 12:53 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:RUSSELL PARK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
570308535
ADMINISTRATOR:SHELBY FARIAFACILITY TYPE:
850
ADDRESS:400 RUSSELL PARKTELEPHONE:
(530) 753-2487
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:80CENSUS: 51DATE:
05/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sarah TibbettTIME COMPLETED:
01:30 PM
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On 05/05/2023 Licensing Program Analyst Katy Maestas (LPA1) and Licensing Program Analyst Jennie Tedlos (LPA2) conducted a Case Management inspection at the Center regarding a self-reported Unusual Incident Report (UIR) dated 04/19/2023. LPAs arrived at the Center and were met by the Director Shelby Faria (D1). LPAs disclosed the purpose of the inspection and were granted entrance into the facility. The Site Supervisor Sarah Tibbett (D2) arrived shortly after the LPAs. Both D1 and D2 assisted LPAs with the investigation.

LPAs toured the Center and observed 51 preschool aged children being supervised by 9 staff members. LPA1 determined, through accessing Guardian, that all required adults were background cleared and associated to the license. LPAs conducted staff and children interviews, reviewed staff and children's files and requested documentation of the Facility Roster.

An exit interview was conducted with D1 and D2 in which the report was reviewed. LPA1 provided D2 with Licensee Appeal Rights. No deficiencies were cited in today's visit, 05/05/2023, in the areas that were evaluated. A Notice of Site visit was posted by LPA1 and must remain posted for 30 days. Failure to comply with posting requirements will result in an immediate Civil Penalty of $100.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Nola MaestasTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2023
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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