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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553615368
Report Date: 10/17/2024
Date Signed: 10/17/2024 05:05:49 PM

Document Has Been Signed on 10/17/2024 05:05 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:TWAIN HARTE PM CLUBFACILITY NUMBER:
553615368
ADMINISTRATOR/
DIRECTOR:		SAMANTHA RICEFACILITY TYPE:
840
ADDRESS:18815 MANZANITA DRIVETELEPHONE:
(209) 768-8005
CITY:TWAIN HARTESTATE: CAZIP CODE:
95383
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 15DATE:
10/17/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Samantha RiceTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On October 17, 2024, Licensing Program Analyst (LPA) Tobias Lake and Licensing Program Manager (LPM) Bettina Engleman met with Site Supervisor, Samantha Rice for the purpose of an unannounced annual inspection. Facility days and hours of operation are Monday-Friday from 12:00 PM to 5:30 PM. There were 15 children present at the start of today's inspection. LPA reviewed the sign in/out book and observed that the children are properly signed in.

Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA toured the facility inside and out. LPA observed that hazardous items were inaccessible to children in care. LPA reviewed staffing ratios, first aid supplies, fire drills and drinking water. LPA observed all required forms to be posted. Administrator stated the fire alarm system includes carbon monoxide as well and is maintained by the school district. LPA observed the toys, furniture and equipment to be in good condition. Outdoor play area was toured. Facility provides snacks to children in care.

LPA reviewed children’s and staff files. LPA observed health screening reports and discussed the requirement of immunization's for all staff and children. LPA observed at least one staff member present to have current Pediatric CPR and First Aid. LPA discussed the requirement for all staff to have a valid AB1207 Mandated Reporter training certificate. The site supervisor was reminded to renew the course every 2 years through www.mandatedreporterca.com website.

Report continues on 809-C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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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: TWAIN HARTE PM CLUB
FACILITY NUMBER: 553615368
VISIT DATE: 10/17/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/
LPA observed lead testing clearance on file.

Licensee 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Exit interview conducted and report was reviewed with the Administrator, Samantha Rice. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements may result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC809 (FAS) - (06/04)
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