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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624100
Report Date: 12/10/2021
Date Signed: 12/10/2021 12:05:47 PM

Document Has Been Signed on 12/10/2021 12:05 PM - 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:SLADE, JESSICA & BENJAMINFACILITY NUMBER:
343624100
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/10/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Benjamin & Jessica SladeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Michelle Pascual met with applicant Jessica Slade for the purpose of a pre-licensing visit. Present was the applicant's husband, Benjamin Slade, all individuals have fingerprint clearances.

A health and safety inspection was conducted inside and out. The two-story house consists of a front room, dining room, kitchen family room, laundry room, one bedroom and one bathroom downstairs. Also, downstairs is the preschool, located in a separate room that was converted. Upstairs there are four bedrooms and two bathrooms. Outside there is a front yard & a backyard. The off-limit areas: Entire upstairs (blocked by gate) and downstairs closet and storage room that is off of the preschool. Off-limits areas will remain inaccessible to children through supervision. The applicant acknowledges that she must contact LPA prior to making an off-limits area on-limits and vice versa. Toxic and hazardous items are inaccessible to children. Functioning smoke and carbon monoxide detectors and a fire extinguisher were observed in the home. Applicant will replace fire-extinguisher with a 2A10BC. There are no bodies of water on the premises. Applicant knows that 100% supervision must be provided when children are playing outside in the front yard.

LPA verified current in-person EMSA pediatric CPR (exp 12/2023) and First Aid certification as well as mandatory Reporter Training (exp 11/23). Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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: SLADE, JESSICA & BENJAMIN
FACILITY NUMBER: 343624100
VISIT DATE: 12/10/2021
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Incidental Medical Services (IMS) policy was discussed. Applicant will provide an IMS plan to the LPA as IMS are being provided. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

New Safe Sleep regulations were discussed and explained.

This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of 3 years for public review upon request. Their signature on this form acknowledges receipt of this form

Effective today, 12/10/2021, this home is licensed for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
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