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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570308535
Report Date: 09/28/2023
Date Signed: 09/28/2023 01:32:18 PM


Document Has Been Signed on 09/28/2023 01:32 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 53DATE:
09/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sarrah TibbettTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Erwin Tjhia met with Director, Sarah Tibbett for the purpose of an unannounced Annual inspection. Facility days and hours of operation are Monday-Friday from 8 AM to 5 PM. Facility provides breakfast, lunch and snack. There were 53 children present during today's inspection, including 18 toddlers. There is a waiver on file for allowing LA Rue Child Development Center (LIC#573604201) as the central administrative file for criminal record association purposes. The waiver is being followed according to terms.

All staff present during today's inspection have a fingerprint clearance. The director 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.

LPA toured the facility inside and out. LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured, the play structure appeared to be in good repair, and there is sufficient cushioning (wood chip) under the play structure. LPA reviewed the sign in/out electronically and observed that the children are properly signed in/out.



LPA reviewed children’s and staff files. LPA did observed complete immunization record for all staffs. At least one staff member present today has current Pediatric CPR and First Aid (exp. 01/31/2024). LPA observed all staff has current AB1207 Mandated Reporter training certificates. The Director was reminded to renew the course every 2 years through www.mandatedreporterca.com website. Report Continue on 809-C
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RUSSELL PARK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 570308535
VISIT DATE: 09/28/2023
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This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medications and equipment/supplies, and reviewed children’s personnel, and administrative records.

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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Facility director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the facility Director, Sarah Tibbett. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during the inspection
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC809 (FAS) - (06/04)
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