Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570311582
Report Date: 01/28/2016
Date Signed 01/28/2016 04:30:20 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:RUSSELL PARK CHILD DEVELOPMENT CENTER (INFANTS)FACILITY NUMBER:
570311582
ADMINISTRATOR:TANYA CHORDASFACILITY TYPE:
830
ADDRESS:400 RUSSELL PARKTELEPHONE:
(530) 753-2487
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:12CENSUS: 11DATE:
01/28/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Tatyana ChordesTIME COMPLETED:
04:50 PM
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LPA Joseph Bweupe conducted an annual random visit. LPA met with the facility director. LPA toured the facility, including all activity/classroom areas, isolation area, food service area, rest-rooms, diaper changing room and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications and first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions.
LPA reviewed children's records. Files contained identification and health information (LIC 701 and LIC 702)l LPA also reviewed staff records. Staff files contained health screening information (LIC 503). LPA observed all required forms to be posted. Director stated that facility did not have any medications. Some first aid materials were available. Facility had sleeping mattresses, blankets and labeled cubbies for each infant. There were adequate toys available for children. Facility had a diaper changing room which had a changing table. There was a sink within arm's reach to the table in the room. Director stated that facility does not provide meals for infants. Director added that parents bring meals including formula. Facility had needs and services plans for infants in binders located on the shelf on the walls. Infant Formula is labelled by names for all infants. LPA observed children's labels in the refrigerator where food is stored. Director stated that facility keeps a log for children once they are fed. LPA observed log which was located on the wall in the infant room. All staff present had criminal record clearances. Facility has an updated fire drill log. LPA reviewed the sign in/out sheets, children's and personnel records. Facility had 11 infants with 4 staff.
At least one staff member present had current Pediatric CPR and first Aid. LPA advised director of cite visit posting requirement and the licensee/director's requirement to post reports with include type A deficiencies. LPA provided the licensing Agency website www.ccld.ca.gov for the director and staff to obtain updated information., regulations and forms.There were no deficiencies during the visit. Exit interview was conducted. Notice of visit was posted
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5744
LICENSING EVALUATOR NAME: Joseph BweupeTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2016
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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