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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313617646
Report Date: 08/26/2024
Date Signed: 08/26/2024 09:19:35 AM

Document Has Been Signed on 08/26/2024 09:19 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ADVENTURE CLUB - FIDDYMENT FARMFACILITY NUMBER:
313617646
ADMINISTRATOR/
DIRECTOR:		BARROW, CAROLYNFACILITY TYPE:
840
ADDRESS:4001 BRICK MASON CIRCLETELEPHONE:
(916) 783-2040
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 0DATE:
08/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Dylan Davis- Recreation SupervisorTIME VISIT/
INSPECTION COMPLETED:
09:20 AM
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An unannounced case management inspection was conducted today by Licensing Program Analyst Owens. LPA Owens met with Dylan Davis, Recreation Supervisor and Child Care site supervisor, Carolyn Barrows. No children were present during the inspection.

The purpose of the inspection is to confirm that an employee is not at or employed at the facility. This individual was confirmed to have been terminated on 10/24/22 and is no longer at the facility.

No deficiencies issued.
See confidential names
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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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