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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343606960
Report Date: 12/10/2024
Date Signed: 12/10/2024 04:50:47 PM

Document Has Been Signed on 12/10/2024 04:50 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:4TH R - TWO RIVERSFACILITY NUMBER:
343606960
ADMINISTRATOR/
DIRECTOR:		JEANINNIE SELFFACILITY TYPE:
840
ADDRESS:3201 WEST RIVER DRIVETELEPHONE:
(916) 277-3849
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 46DATE:
12/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:15 PM
MET WITH:Courtney FloydTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On Tuesday 10 December 2024, at approximately 4:15pm Licensing Program Analyst (LPA) Fabian Schwartz met with Facility Representative Courtney Floyd to conduct a case management inspection. LPA came to facility to conduct interviews for previous complaint investigation. At time of inspection, LPA observed facility was supervising 46 school aged children with 10 staff.

No deficiencies were cited during inspection. Notice of site visit was given and exit interview was conducted with Facility Representative.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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