293619733-2-13-2020-03-CC-BMOS-BLRRSF-20200213121640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293619733
Report Date: 02/13/2020
Date Signed: 02/13/2020 12:16:46 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:	ROBYN, JESSICA		FACILITY NUMBER:	293619733
ADMINISTRATOR:	ROBYN, JESSICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 615-6908
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	14	CENSUS: 7	DATE:	02/13/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Jessica Robyn - Licensee		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Blake Morillas met with the Licensee, Jessica Robyn, for the purpose of an unannounced Annual/Random inspection. The Licensee's Assistant was also present upon arrival. All individuals subject to criminal background review have obtained a criminal record clearance. Today’s census was 7 preschool age children. Operating hours are 5:30am to 3:00pm, Monday through Friday, year around. A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the Master Bedroom and Garage. Licensee acknowledged that children may never enter these off-limit areas. LPA observed a working phone, fire extinguisher, and functioning smoke and carbon monoxide detectors. Licensee stated there are no weapons in the home. Toxic and hazardous items (detergents, cleaning compounds, medications, sharp utensils, items that could pose a danger to children in care) are properly stored and inaccessible to children. There is non-operable fireplace at the home that has been sealed to prevent access by children in care. There are no stairs in the home. Safe toys and play equipment are observed. The outdoor play space is fenced. At this time there are no bodies of water on the premises. *Continued on LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

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: ROBYN, JESSICA	FACILITY NUMBER: 293619733
	VISIT DATE: 02/13/2020

NARRATIVE

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*Continuation of LIC 809

Children’s files were reviewed. A current roster is being maintained. Licensee's fire and disaster drills are conducted and documented. Preventative health training, current pediatric CPR and First Aid certification was verified for the Licensee (expires 9/2020). Mandated Reporter Training (AB 1207) and immunizations for Licensee and Assistant was also verified.

This provider is currently not providing IMS services to children in care. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

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 and discussed the Safe Sleep in Child Care and Lead Testing brochures (AB 2370).

LPA reviewed and discussed this facility evaluation report with the Licensee. LPA provided a Notice of Site Visit and the Licensee acknowledges that this notice should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at http://ccld.ca.gov for child care updates, current forms, legislation and regulation information.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

The Licensee's signature on this form acknowledges receipt of this form.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake Morillas	TELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020

LIC809 (FAS) - (06/04)

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