Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313615384
Report Date: 04/24/2017
Date Signed 04/24/2017 11:37:10 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:
04/24/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Janice GriswoldTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Keven Peters met with the Director for an annual/random visit. LPA toured the facility, including all activity/classroom areas, the isolation area, food service area, restrooms and outdoor play areas. LPA reviewed health related services, including medications and first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions. There were not children at the facility during today’s visit.

LPA observed all required forms to be posted. Medications are stored in a cabinet inaccessible to children in care. Some first aid materials were available. There are adequate toys and equipment available for children. The restrooms were observed to be in working order. The center provides snacks and menus were posted in the kitchen.
LPA reviewed the sign/in-sign/out sheet, children's and personnel records. All staff currently employed with the Center has criminal record clearances through the city of Roseville. At least one staff member present today has current Pediatric CPR and First Aid.
LPA discussed recent changes in licensing requirements, including SB 277 and SB 792 pertaining to immunization requirements for children and staff. Facility provided documentation showing all staff meet immunization requirements.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2017
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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ADVENTURE CLUB - JUNCTION
FACILITY NUMBER: 313615384
VISIT DATE: 04/24/2017
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The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA provided the Licensing Agency website (www.ccld.ca.gov), so the director and/or staff may obtain updated licensing information, regulations, and forms.



No deficiencies were cited during the visit.
Report was reviewed with director, exit interview conducted.

Notice of Site Visit was posted.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2017
LIC809 (FAS) - (06/04)
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