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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313625148
Report Date: 11/13/2024
Date Signed: 11/13/2024 10:07:49 AM

Document Has Been Signed on 11/13/2024 10:07 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 - REX FORTUNEFACILITY NUMBER:
313625148
ADMINISTRATOR/
DIRECTOR:
SARAH BEESONFACILITY TYPE:
840
ADDRESS:4601 UPLAND DRIVETELEPHONE:
(916) 517-5791
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
11/13/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Dylan Davis- Recreation SupervisorTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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A case management inspection was conducted today by Licensing Program Analyst Owens and McClain. LPA's met with Recreation Supervisor Dylan Davis and Antoinette Dutro, Program Coordinator. The purpose of the inspection is do a room change for the school- age adventure club program located on the Rex Fortune Elementary School premises; the room change is still on the same school premises. The school-age program is license to serve 60 school-age children enrolled in kindergarten and above. The program will operate Monday through Friday from 6:00 AM to 6:00 PM. The original school fire clearance was approved on 7/3/2023. The school-age program will be using the Rex Fortune Elementary school restrooms; escorted by staff. The school-age program will continue to share the outdoor play area as previously approved.

Supervisor acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. The facility will be providing an afternoon snack.

LPA observed a sufficient amount of equipment, tables, and chairs. There is a first aid kit and medications will be stored in the classroom in an inaccessible area. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Supervisor stated there are no poisons or firearms on the premises.

According to Title 22, Division, 12 Section 101538.2(c) & 101538.3 (c), the school-age program is exempt from the indoor and outdoor square footage measurements.

Upon return to the licensing office, a file review of the facility file will conducted by the LPA and LPM for approval of the room change. Upon approval, licensing will update the license to indicate the new licensed rooms 1 & 2.
SUPERVISORS NAME: Jennifer Brekke
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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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