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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623875
Report Date: 02/03/2023
Date Signed: 02/03/2023 02:03:03 PM

Document Has Been Signed on 02/03/2023 02:03 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:4TH R - PASO VERDEFACILITY NUMBER:
343623875
ADMINISTRATOR:GALINDO, JESSICAFACILITY TYPE:
840
ADDRESS:5240 PV SCHOLARS LANETELEPHONE:
(916) 203-2716
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 0DATE:
02/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jessica GalindoTIME COMPLETED:
02:20 PM
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On February 3rd, 2023, Licensing Program Analyst (LPA) Arianna Manabat met with Program Coordinator for an unannounced annual inspection. At approximately 12:45PM, LPA toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Census included zero school age children in care with four staff. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday 7:00-8:00AM and 2:00pm to 6:00 PM.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Classrooms all appeared clean including the carpets and floor. Chemicals and cleaning materials were kept inaccessible to children. Playground equipment and surfaces were inspected and are in good condition with enough resilient material under climbing structures to absorb a fall. Drinking water was readily available to children both indoors and outdoors in water bottles. Playground provided shade via awnings. Bathrooms were clean and all sinks and toilets were in operating condition.

The Program Coordinator states that there are no firearms or bodies of water on the premises and the facility has at least one functioning smoke and carbon monoxide detector. Menus were posted for PM snack and the children are provided lunches from home. LPA observed the appropriate postings were visible to parents. LPA Manabat observed a current children's roster and a fire/disaster drill log. The facility is equipped with First Aid equipment. LPAs observed parents are signing their children in and out of the center electronically. Continued on LIC 809-C.....
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: 4TH R - PASO VERDE
FACILITY NUMBER: 343623875
VISIT DATE: 02/03/2023
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... Continued from LIC 809......

LPA Manabat reviewed staff files and transcripts and observed all staff being utilized as teachers were qualified. LPA Manabat observed current Mandated Reporter certificates and proof of immunization for the staff. At least one staff had a current Pediatric CPR and First Aid certification that expires Jan 2024. LPA has observed the sample of children’s files and it contained the appropriate amount of documentation.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (UShttp://www.ada.gov/childqanda.htm

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/inspection-process.
Facility Representative was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.

No citations were issued based on today’s inspection. Exit interview was conducted and report was reviewed with the Facility Representative. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Arianna Manabat
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC809 (FAS) - (06/04)
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