Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313615384
Report Date: 11/20/2015
Date Signed 11/20/2015 10:08:34 AM

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 - JUNCTIONFACILITY NUMBER:
313615384
ADMINISTRATOR:GRISWOLD, JANICEFACILITY TYPE:
840
ADDRESS:2150 ELLISON DRIVETELEPHONE:
(916) 772-4988
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:90CENSUS: 0DATE:
11/20/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Janice GriswoldTIME COMPLETED:
10:25 AM
NARRATIVE
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Licensing Program Analysts (LPA's) Keven Peters & Steven Lunn met with the director for an annual/random visit. LPA toured the buildings including all activity/classroom areas, food service area, rest-rooms and outdoor play areas. LPA reviewed care and supervision of children areas, staffing ratios as required for school age component, health related services, including medications, furniture, equipment, drinking water and food service provisions. There were no children in care at time of visit.

LPA reviewed the sign/in-sign/out sheet as required for school age component, and at least one staff member present today has current Pediatric CPR and First Aid. All staff currently employed with the facility have criminal record clearances. LPA reviewed children's Identification and Emergency information and staff's LIC 503 Health Screening and TB Test.

LPA provided the Licensing Agency website (www.ccld.ca.gov), so the licensee may obtain updated licensing information, regulations, and forms. LPA also explained the new Zero Tolerance and immediate Civil Penalty regulation deficiencies and citations that came into effect on 1/18/11.

In the areas that were evaluated, no deficiency was cited during the visit.

Exit interview was conducted. Notice of Site Visit posted.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2015
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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