Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603166
Report Date: 07/15/2015 12:00:00 AM
Date Signed 07/15/2015 02:15:18 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:ELK GROVE SCHOOL AGE CDCFACILITY NUMBER:
343603166
ADMINISTRATOR:MONICA CHANEYFACILITY TYPE:
840
ADDRESS:9373 CROWELL DRIVETELEPHONE:
(916) 686-6495
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:70CENSUS: 24DATE:
07/15/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Monica Chaney - Site SupervisorTIME COMPLETED:
02:30 PM
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(1) An unannounced annual/random visit is made today by Licensing Program Analyst (LPA) Katrina Owens on the school-age program. Met with Monica Chaney, Site Supervisor. A tour of facility was conducted inside and outside. Staff and children were spoken to during visit. The following areas are in compliance during visit: There are no bodies of water. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Currently no medication is being administered. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted according to regulations. The playground equipment and outdoor activity space is maintained and in good condition. Wood chip is being used as cushioning around the climbing equipment. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered and all food or beverages are stored in covered containers at 45 degrees or less. School-age are served a breakfast, lunch and snack. Drinking water is available both indoors and outside. Menus are posted. The facility is in compliance with conditions and limitations specified on the license. Teacher/child ratios are maintained and adequate supervision is being provided during this visit. Sign in/sign out sheets maintained. No excluded individuals are present. Staff subject to a criminal record clearance or exemption are associated to the facility. First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Staff records reviewed contain documentation of the educational background, training, and/or experience. Operating hours are Monday thru Friday;7:00 AM and 6:00 PM.

No deficiencies observed in the areas inspected during today's visit.

A COPY OF THIS REPORT MUST REMAIN IN THE FACILITY FOR PUBLIC REVIEW.
NOTICE OF SITE VISIT FORM POSTED TO PARENT'S BOARD.

To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2015
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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