343620037-5-25-2023-03-CC-KGUA-CS6USR-20230525155045

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343620037
Report Date: 05/25/2023
Date Signed: 05/25/2023 03:50:51 PM

Document Has Been Signed on 05/25/2023 03:50 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	CHILDREN'S RECEIVING HOME OF SACRAMENTO		FACILITY NUMBER:	343620037
ADMINISTRATOR:	CRYSTAL ROSARIO		FACILITY TYPE:	850
ADDRESS:	3555 AUBURN BLVD		TELEPHONE:	(916) 482-2370
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY: 10	TOTAL ENROLLED CHILDREN: 10	CENSUS: 0	DATE:	05/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Joshua Barlow and Crystal Rosario		TIME COMPLETED:	04:00 PM

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At 1:45 p.m. on Thursday, May 25th, 2023, licensing Program Analyst (LPA) Karyn Guerra met with Clinical Program Manager, Joshua Barlow, and Site Supervisor, Crystal Rosario, for the purpose of an unannounced, required - 1 year inspection. There were no children present during inspection, as they were being transported home by staff. Facility hours of operation are from 8:30 a.m. - 1:00 p.m., Monday thru Friday.

Criminal record clearances are associated to on site Children's Residential program. Site Supervisor 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 health and safety inspection was conducted in the classrooms, restrooms, and outdoor play areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children. Furniture and equipment are in good condition, and toileting facilities are in safe, sanitary, and operating condition. One urinal is out of order. Bins for solid waste in the have tight fitting lids. LPA discussed stains observed on area rug. Site Supervisor stated that a work order has been placed. The facility provides breakfast, lunch, and snack. Drinking water was readily available to children both indoors and outdoors via drinking fountains. Clinical Program Manager stated that lead testing of drinking water has been conducted. LPA observed full legal signatures of authorized representatives in sign in/ sign out logs. There are no firearms nor bodies of water on the premises. Previously existing pool has been demolished and replaced with a gazebo and grass area. LPA observed a functional carbon

Report continues on 809-C.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CHILDREN'S RECEIVING HOME OF SACRAMENTO	FACILITY NUMBER: 343620037
	VISIT DATE: 05/25/2023

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monoxide detector. Fire drills have been conducted and documented. Playground equipment and surfaces are free of loose or sharp parts. Outdoor shade is provided by trees. LPA observed rubber mulch beneath the play structure to provide cushioning.

Staff files were reviewed. At least one staff member present today has current Pediatric CPR and First Aid certification. LPA observed immunization records and documentation of the educational background, training, and/or experience and AB 1207 Mandated Reporter training certificates.

Children's records were reviewed. Each child's file contained an emergency card, consent for emergency medical treatment and notifications of children’s and parent’s rights, health history, physician's report and immunization records.

This facility does not provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

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.

A staff interview was conducted with the Site Supervisor, Crystal Rosario. LPA informed of Regional Office location change and provided updated parent's and personal rights forms. LPA requested follow up designation of Licensee Representative.

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/process.

In the areas that were evaluated, no deficiencies were cited during today’s inspection. Exit interview conducted and report was reviewed with Site Supervisor, Crystal Rosario. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC809 (FAS) - (06/04)

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