Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313610190
Report Date: 12/03/2015
Date Signed 12/03/2015 02:40:58 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-THOMAS JEFFERSONFACILITY NUMBER:
313610190
ADMINISTRATOR:SALCI, CAROLFACILITY TYPE:
840
ADDRESS:750 CENTRAL PARK DRIVETELEPHONE:
(916) 774-5169
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:60CENSUS: 6DATE:
12/03/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:24 PM
MET WITH:Carol Salci, DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Amanda Blesi met with Carol Salci for a random annual inspection. This facility is located on the elementary school grounds in the Adventure Club portable. Also present were 6 children and 3 staff. This facility is licensed for 60 school age children in the portable which is divided into two separate rooms. The facility provides snacks for the children. LPA toured the facility including all activity/classroom areas, the isolation area, and food service area. Facility utilizes the elementary school bathroom and playground. LPA reviewed care and supervision of children, staffing ratios, health related services, furniture, equipment, drinking water and food service provisions.

LPA reviewed the children's Identification and Emergency Information. LPA reviewed staff personnel's education requirements. All staff currently employed with the Center have criminal record clearances and are associated to the Adventure Club - Fiddyment Farm site (waiver on file). At least one staff member present today has current EMSA approved Pediatric/Child CPR and First Aid. This facility provides Incidental Medical Services-IMS. LPA reviewed the storage of medication and equipment and supplies, and reviewed children’s, personnel, and administrative records. LPA discussed the need to update the centers plan of operation to reflect IMS plan. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173.

There were no deficiencies observed during today's visit.

Exit interview and 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: 12/03/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2015
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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