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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343606960
Report Date: 02/18/2025
Date Signed: 02/18/2025 01:44:39 PM

Document Has Been Signed on 02/18/2025 01:44 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: 0DATE:
02/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Tamara O'CallaghanTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On Tuesday, 18 February, 2025 at approximately 12:00 PM, Licensing Program Analyst (LPA) Fabian Schwartz met with Program Coordinator Tamara O’Callaghan for the purpose of an unannounced annual random inspection. LPA observed care and supervision of 0 School aged children due to inspection occurring outside of childcare hours. All persons requiring criminal background checks have been cleared through Guardian system. The license has a maximum capacity of 150. The facility hours of operation are Monday through Friday 7:00 AM to 8:00 AM and 1:30 PM to 6:00 PM.

LPA toured the classrooms, restrooms, outdoor play areas, and occasional use classrooms. Facility operates in two portable rooms, Room P1, Room P2, Room E13, Room C3, and Room E3. Teacher stated there are no firearms on the premises. Toxic and hazardous items are inaccessible to children and are stored locked cabinet. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts and the ground below the play structures is sufficiently padded with bark. Restrooms are in sanitary condition with functioning toilets. The floors were clean throughout the facility. Medications are stored out of children’s reach and labeled according to regulation. During inspection, LPA observed Epinephrine Auto Injector Medication which was past the expiration date.

LPA observed that solid waste containers were covered. Drinking water was readily available to children both indoors and outdoors. LPA observed a electronic sign in and out device near the entrance.

All present staff files were reviewed. LPA observed a current Mandated Reporter certificate for every staff member and a current CPR and First Aid certificate which will expire 10 January 2026. LPA observed completed facility roster and fire drill log last updated 23 January 2025.

Report continues on LIC809-C…

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: 4TH R - TWO RIVERS
FACILITY NUMBER: 343606960
VISIT DATE: 02/18/2025
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LPA reviewed 3 children’s files and observed them to be complete. LPA observed first aid equipment, functioning smoke and carbon monoxide detectors which are hardwired into the classroom fire alarm system, and fully charged fire extinguishers meeting regulation. Required documents were posted.

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.

Director 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.

Report continues on LIC809-C…

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
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 - TWO RIVERS
FACILITY NUMBER: 343606960
VISIT DATE: 02/18/2025
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This facility does provide Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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/.

Based on today’s inspection, 1 Type A Title 22 deficiency has been issued for having an expired children’s medication at facility. Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, Director shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Facility. LIC 9224 and Appeal Rights were provided. Licensee's signature on this report acknowledges receipt of these rights.


Exit interview was conducted and report was reviewed with the Program Coordinator. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
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Document Has Been Signed on 02/18/2025 01:44 PM - It Cannot Be Edited


Created By: Fabian Schwartz On 02/18/2025 at 01:28 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: 4TH R - TWO RIVERS
FACILITY NUMBER: 343606960

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above by having 1 expired Epinephrine autoinjector which had an expiration date of November 2024 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/19/2025
Plan of Correction
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Director will get a current Epinephrine Autoinjector for Child #1 and email LPA proof of current medicine at facility by 19 February 2025.
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:Amanda Blesi
LICENSING EVALUATOR NAME:Fabian Schwartz
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2025


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