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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313608848
Report Date: 01/10/2023
Date Signed: 01/10/2023 02:08:47 PM

Document Has Been Signed on 01/10/2023 02:08 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:ADVENTURE CLUB - STONERIDGEFACILITY NUMBER:
313608848
ADMINISTRATOR:RACHEL CLEVELANDFACILITY TYPE:
840
ADDRESS:2501 ALEXANDRA DR.TELEPHONE:
(916) 771-5684
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 6DATE:
01/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Taylor JamisonTIME COMPLETED:
02:15 PM
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On January 10th, 2022, Licensing Program Analyst (LPA) Jeremey McClain met with Licensing Representative Talyor Jamison for an unannounced required annual random inspection. LPA observed care and supervision of 6 school age child by three teachers.

LPA inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items are inaccessible to children. Furniture and equipment are in operable and safe condition. Playground equipment and surfaces are free of loose or sharp parts, and adequate cushioning was observed in areas underneath climbing equipment. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. The food preparation space is free of litter and all food was protected against contamination. Storage containers with solid waste have tight-fitting covers in each classroom. Medications are appropriately stored and inaccessible to children. LPA observed a functional carbon monoxide detector.

Afternoon snacks are provided by the facility. LPA observed posted menus showing planned meals at least one week in advance. Drinking water is readily available to children both indoors and outdoors. LPA observed full legal signatures while reviewing the sign in and sign out sheet.

LPA reviewed records for all present staff. At least one staff member present today has current Pediatric CPR and First Aid certification which expires: 5/11/2024. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience.

Three children records were reviewed. Each child's file contained a completed emergency contact form, immunization records, signed personal rights form, and a completed medical assessment.

Report Continued on the following page.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ADVENTURE CLUB - STONERIDGE
FACILITY NUMBER: 313608848
VISIT DATE: 01/10/2023
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Incidental Medical Services (IMS) policy was discussed. The facility is currently providing IMS and has a plan of operation in place. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/(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.

LPA encouraged the Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining childcare centers. LPA also encouraged the Director to sign up for the Child Care Advocates quarterly newsletter.

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.

Deficiencies are cited on the following page of the report.

This report was reviewed with licensee, and an exit interview was conducted.



A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023
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Document Has Been Signed on 01/10/2023 02:08 PM - It Cannot Be Edited


Created By: Jeremey McClain On 01/10/2023 at 01:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ADVENTURE CLUB - STONERIDGE
FACILITY NUMBER: 313608848

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
WD
101700.3(b)(1)


This requirement is not met as evidenced by:
Deficient Practice Statement
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California Lead Action Level at Child Care Centers. b) Testing results with fractional ppb readings of 0.5 or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. 1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by: results from a lead test of a faucet/fountain on 12/09/22 that indicated an exceedance of 5.5 ppb. which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2023
Plan of Correction
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Use of the the sink and fountain has been stopped, and both have been taped. There is a sign stating do not use. The facility is using two other water sources in the facility that were not found with exceedant lead levels.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Jeremey McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2023


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