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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293625535
Report Date: 03/18/2024
Date Signed: 03/18/2024 11:16:30 AM

Document Has Been Signed on 03/18/2024 11:16 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:DREW, JESSICAFACILITY NUMBER:
293625535
ADMINISTRATOR:DREW, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 401-6673
CITY:NEVADA CITYSTATE: CAZIP CODE:
95959
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jessica DrewTIME COMPLETED:
11:25 AM
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At 9:30 a.m. on 3/18/2024, Licensing Program Analyst (LPA) Matthew Gallo met with applicant Jessica Drew for the purpose of a prelicensing inspection. Applicant has requested a Large Family Childcare Home License to serve up to fourteen children. Applicant has provided proof of prior experience that qualifies them for a large license. Today's census included 0 day care children.

The facility is a 1 bedroom 1 bathroom home consisting of a living room, kitchen, dining nook, bedroom, 2nd bedroom/playroom bathroom, laundry room, and backyard. There is also a left side yard, separate living quarters, shed, and yard behind the shed on the property. Off limit areas include: separate living quarters, shed, and yard behind the shed. The backyard is partially fenced. Applicant understands that children must never enter these areas. Applicant understands that any unfenced areas of the yard require 100% supervision.

Applicant intends to operate 7:30am-4:30pm, Monday-Friday, year-round. Applicant understands they must be present at the facility for 80% of operating hours per day. Applicant understands that their own family members under 10 years old count toward the ratio.

All individuals subject to criminal background review have obtained a criminal record clearance. Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA and applicant toured the entire facility and property. All toxic and hazardous items are inaccessible to children and applicant understands that any cabinet containing such items and is reachable by children must be made inaccessible. LPA observed a 2A10BC fire extinguisher along with functioning smoke and carbon monoxide detectors. Applicant stated that there are no firearms in the facility, and LPA observed no bodies of water on the property. There are no stairways or fireplaces in the home. LPA reviewed required postings with applicant. (Report Continues on 809-C)
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DREW, JESSICA
FACILITY NUMBER: 293625535
VISIT DATE: 03/18/2024
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Applicant provided proof of control of property in the form of a mortgage statement. Applicant understands that until a liability insurance coverage in the amount of $300,000 is provided, the affidavit form LIC282 form will be used.

AB1207 Mandated Reporter training certificate was verified and expires 9/2024, and Pedriatric CPR/First Aid certificate was verified and expires 10/2024. Applicant understands the CPR/First Aid and Mandated Reporter training must be renewed every two years.

LPA reviewed Safe Sleep regulations and provided the Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an


additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on
the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and
recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased
equipment.

Incidental Medical Services was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417 and when any IMS is provided, an updated Plan of Operation that includes 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) 513-0301 (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.html

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Report continues on 809-C
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DREW, JESSICA
FACILITY NUMBER: 293625535
VISIT DATE: 03/18/2024
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This facility evaluation report was reviewed and discussed with the applicant, Jessica Drew. LPA discussed supervision, personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining to family childcare homes.

Effective today, 3/18/2024, the facility is approved for a large license to serve a maximum capacity of 12 children (when there is an assistant present) with no more than four infants, or a maximum capacity of of 14 children with no more than three infants, and one child in kindergarten or elementary school and one child at least age six.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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