Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310317468
Report Date: 10/28/2015
Date Signed 10/28/2015 01:19:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ADVENTURE CLUB SCHOOLAGE - CIRBY SCHOOLFACILITY NUMBER:
310317468
ADMINISTRATOR:NETT, MELANIEFACILITY TYPE:
840
ADDRESS:814 DARLING WAYTELEPHONE:
(916) 772-4818
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:60CENSUS: 0DATE:
10/28/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Melanie Nett, DirectorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Amanda Blesi met with Director Melanie Nett for random annual inspection. This facility is located on the Cirby elementary school grounds in the Adventure Club portable. There were no children present at the time of visit. This facility is licensed for 60 school age children. The facility provides morning and afternoon snacks for the children.

LPA toured the facility including all activity/classroom areas, the isolation area, and food service. The facility has a waiver on file for shared use with the elementary school for the playground and the bathrooms. LPA reviewed care and supervision of children, staffing ratios, health related services, furniture, equipment, drinking water and food service provisions. This facility provides Incidental Medical Services-IMS, however there are no children currently enrolled that require IMS. LPA discussed updates and IMS procedure with director. LPA discussed the need to update the centers plan of operation to reflect IMS plan and provided handouts to director. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173.

LPA reviewed the children's Identification and Emergency Information. All staff currently employed with the Center have criminal record clearances and are associated to the Adventure Club-Fiddyment Farms Fac #313617646 (waiver on file). At least one staff member present today has current EMSA approved Pediatric/Child CPR and First Aid.

There were no deficiencies observed during this visit. Notice of Site Visit Posted.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2015
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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