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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393604720
Report Date: 11/01/2023
Date Signed: 11/01/2023 10:44:13 AM

Document Has Been Signed on 11/01/2023 10:44 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 SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:VAN DER BEEUREN, RITAFACILITY NUMBER:
393604720
ADMINISTRATOR:VAN DER BEEUREN, RITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 836-2440
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
11/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rita VanderBeeurenTIME COMPLETED:
10:50 AM
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On November 1, 2023, Licensing Program Manager (LPM) Bettina Engleman and Licensing Program Analysts (LPAs) Stacey Williams and Corina Beckby met with Licensee, Rita VanderBeeuren for the purpose of conducting a case management inspection. LPAs observed four children (one infant) in care supervised by Licensee and her assistant.

On limit areas were toured during the inspection. Off-limit areas are the entire upstairs of the home and the garage. Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. There is an in-ground pool with 5 foot pool fencing surrounding two sides of the pool in the backyard. Wood fence and the home is on the other two sides of the pool. There are three windows that have immediate access to the pool and all were inspected and have screw locks on the railing to prevent them from opening more than 4 inches. Two of the windows are in the kitchen above the sink. The third window is located in the living room. The pool gate opens away from the pool and self-closes and self-latches.

A pool waiver is on file for the kitchen and living room windows.

Licensee stated that daycare children are allowed to swim in the pool with 100 percent supervision by Licensee and staff. Licensee stated that each child that swims has a signed permission slip that addresses pool requirements with the parent's signature on file. If a child does not have the signed permission slip, they are not allowed to go swimming. No child will be allowed in the pool area without parental permission on file.

Exit interview conducted at which time the report was reviewed with Licensee, Rita VanDerBeeuren. A Notice of Site Visit was posted by LPAs Williams/Beckby and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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