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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623631
Report Date: 11/09/2020
Date Signed: 11/09/2020 11:38:02 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:HAUBER, DEVAFACILITY NUMBER:
293623631
ADMINISTRATOR:HAUBER, DEVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(917) 627-0103
CITY:NEVADA CITYSTATE: CAZIP CODE:
95959
CAPACITY:14CENSUS: 0DATE:
11/09/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Deva HauberTIME COMPLETED:
11:45 AM
NARRATIVE
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*NOTE: Due to Covid-19 and DPH guidelines on social distancing, a Tele-inspection was conducted via Google Duo.*

On Monday, November 9th, 2020, at 10:00am, Licensing Program Analyst (LPA) Blake Morillas began a tele-inspection with Applicant, Deva Hauber, for a Prelicensing inspection. This is a two story, 2 bedroom, 1.5 bathroom home.

The Applicant is applying for a Large Family Child Care license. A Fire Clearance inspection has been completed by the local Fire Department and a certificate has been received.

The anticipated operating hours will be 8:30am to 1:00pm, Monday through Thursday.

At 10:04am, LPA initiated a health and safety tele-inspection with the help of the Applicant of all areas of the home as well as the outdoor area that will be used by the children in care.

Off-limits areas will include all of the down stairs area, outdoor shed, and detached cabin. Applicant acknowledged that children may never enter these off-limit areas.

Fire extinguisher, carbon monoxide and smoke detectors meet regulation. Hazardous cleaning compounds and medications are stored inaccessible and out of reach of children. Licensee noted that there are no weapons in the home. There are no bodies of water on the premises.


*PAGE 1 of 3 - Continued on LIC 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: HAUBER, DEVA
FACILITY NUMBER: 293623631
VISIT DATE: 11/09/2020
NARRATIVE
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*PAGE 2 of 3 - Continuation of LIC 809

Stairs in the home leading to the down stairs area are behind a door, preventing access by children in care. The outdoor area used by children will consist of a fenced low rise deck and a fenced garden/play area. Applicant understand that 100% supervision is required in unfenced areas. Age appropriate toys were observed.

At 10:25am, LPA began to review Children’s files and other documentation that is required for operation of a day care. Applicant rents the home and provided the appropriate forms. LPA reviewed the fire drill requirements.

At this time, the Applicant does not carry liability insurance. LPA explained about obtaining a $300,000 annual aggregate/$100,000 per occurrence liability insurance policy. Applicant understands that until a policy is obtained, they must use the affidavit.

All adult residents received criminal record clearances. LPA reminded Applicant of the applicable Civil Penalty per person for those adults, including your own children, who have not received fingerprint clearances.

The Applicant has completed Mandated Reporter Training. The Applicant also completed CPR/First Aid training (expires: 6/2021).

LPA provided the Lead Testing brochures (AB 2370), went over the recently implemented Infant Safe Sleep Regulations, as well as went over the current guidelines in operating during the Covid-19 Pandemic.


*Continued on LIC 809-C
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: HAUBER, DEVA
FACILITY NUMBER: 293623631
VISIT DATE: 11/09/2020
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*PAGE 3 of 3 - Continuation of LIC 809-C

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 are available online (www.ada.gov/childqanda.htm). Applicant was encouraged to visit the Department website (ccld.ca.gov) for child care updates, current forms, legislation and regulation information. LPA advised the Applicant of their responsibility to stay current with the requirements of the Department.

At 11:17am, LPA reviewed and discussed this facility evaluation report with the Applicant. The Applicant was informed that when a physical inspections takes place, requests for alterations may be made.



Effective today (11-9-2020) the facility is LICENSED to serve a MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

This report and a Notice of Site Visit will be delivered to the Applicant electronically. Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3