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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312840
Report Date: 08/28/2023
Date Signed: 08/28/2023 11:21:57 AM

Document Has Been Signed on 08/28/2023 11:21 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:4TH R - SEQUOIAFACILITY NUMBER:
340312840
ADMINISTRATOR:MICHELE CARTHENFACILITY TYPE:
840
ADDRESS:3333 ROSEMONT DRIVETELEPHONE:
(916) 277-6105
CITY:SACRAMENTOSTATE: CAZIP CODE:
95826
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 27DATE:
08/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Samantha HuiTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Gagandeep Singh met with facility representative, Samantha Hui, for an unannounced annual inspection. Purpose of the inspection was explained. The facility operates at school site. Upon LPA’s arrival, there were 27 children in care with four staff members. Facility is operating with in the capacity and in compliance with staff child ratio on this day. Facility operate day care from Monday to Friday between 7 AM to 6 PM.

During inspection, LPA inspected the day care classrooms. Facility has multiple smoke detectors, fire alarms and fire extinguishers at the site. Facility has carbon monoxide detector, first aid supplies and working telephone at the site. All of the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Furniture is steady and in good repair. All of the unused electrical outlets have child protective covers installed. Facility has gender separated toilets. All toilets, hand washing facilities are in working condition with proper sanitation in place. Facility has drinking water available for children. Play yard is free of hazards. Facility has age appropriate play structures. All of the play structures are steady, in good repair and free of any loose parts. There is sufficient amount of wood chips under the play structures to prevent any fall injuries. Play yard has shaded areas in play yard for children.

LPA reviewed the facility records. LPA observed facility has all of the required documents posted next to the entrance door. LPA reviewed random children's and staff's files. LPA observed facility has record of names, addresses and telephone numbers of each child's authorized representative. One of the present staff members has record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers. LPA reminded the facility representative that fire drill must be done at least once a month and must be logged. Facility has log in place. See next page for continuation .................
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: 4TH R - SEQUOIA
FACILITY NUMBER: 340312840
VISIT DATE: 08/28/2023
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Facility representative 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information

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/.

No deficiencies were cited during today's inspection. Copy of this report was reviewed and provided to the facility representative. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
LIC809 (FAS) - (06/04)
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