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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293624237
Report Date: 07/27/2022
Date Signed: 07/28/2022 09:43:37 AM

Document Has Been Signed on 07/28/2022 09:43 AM - It Cannot Be Edited

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:CARMONA, JESSICAFACILITY NUMBER:
293624237
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
07/27/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jessica CarmonaTIME COMPLETED:
10:30 AM
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On Wednesday, July 27, 2022 at 9:30 AM, Licensing Program Analyst (LPA) Amanda Sutter and Alize Tillery met with licensee Jessica Carmona for the purpose of a Capacity Increase from 8 to 14 children. The Fire Safety Inspection Clearance has been received from the Nevada County Fire Department on July 7, 2022 and the home has been cleared for up to 14 children. All individuals subject to criminal background review have obtained a criminal record clearance. Eight children were present in the facility.

A health and safety evaluation was conducted in all areas accessible to children. The home is two story. Off-limit areas include: Garage, living room, cellar, and upstairs. Licensee acknowledged that children may never enter these off-limit areas. Licensee acknowledged that children may never enter these off-limit areas. LPA observed a current roster of the enrolled children and fire drill log.

Large family child care home capacity limitations were reviewed during today's visit. Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity

Effective today, July 27, 2022, LPA will approve the capacity increase to serve up to either 14 children, two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. Exit interview conducted. Notice of site visit posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2022
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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