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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621312
Report Date: 10/22/2024
Date Signed: 10/22/2024 01:25:27 PM

Document Has Been Signed on 10/22/2024 01:25 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:RIVER CITY EARLY LEARNING CENTER (INF)FACILITY NUMBER:
343621312
ADMINISTRATOR/
DIRECTOR:		MELENDEZ, MONIQUEFACILITY TYPE:
830
ADDRESS:3050 BABSON DRIVETELEPHONE:
(916) 691-6420
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 12DATE:
10/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Monique MelendezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 10/22/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection regarding a self reported Unusual Incident Report (UIR) dated 10/17/2024. LPA arrived at the facility and was met by Director Monique Melendez (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 12 infants being supervised by 2 staff members during nap time. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

LPA conducted staff interviews and reviewed documentation pertaining to the UIR. Interviews and documentation corroborate what was reported in the UIR: an infant was fed the incorrect bottle. This poses a potential risk to the health and safety of children in care. As a result, a Type-B deficiency was cited on a subsequent 809-D page.

An exit interview was conducted, and the report was reviewed with Director Melendez. LPA provided D1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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Document Has Been Signed on 10/22/2024 01:25 PM - It Cannot Be Edited


Created By: Katy Velazquez On 10/22/2024 at 12:46 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: RIVER CITY EARLY LEARNING CENTER (INF)
FACILITY NUMBER: 343621312

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/29/2024
Section Cited
CCR
10142(c)

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Infant Care Food Service...(c) The infant shall be fed in accordance with the individual plan.
This requirement was not met as evidenced by a child being served the incorrect bottle on 10/17/2024.
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Director Melendez will create a bottle feeding procedure, which includes a Face-to-Name check document. Director Melendez will train infant staff on the new bottle procedure and have infant staff sign that they have reviewed the new bottle procedure.
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This poses/posed a potential health, safety, or personal rights risk to persons in-care.
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Director Melendez will email LPA the infant staff signatures for bottle review by 5:00 PM on 10/29/2024.

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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:Karyn Guerra
LICENSING EVALUATOR NAME:Katy Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024


LIC809 (FAS) - (06/04)
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