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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624100
Report Date: 06/16/2022
Date Signed: 06/16/2022 04:21:36 PM

Document Has Been Signed on 06/16/2022 04:21 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: 8DATE:
06/16/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Benjamin & Jessica SladeTIME COMPLETED:
11:00 AM
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LPA Pascual met with licensees Benjamin & Jessica Slade for the purpose of a case management visit to view the progress of the backyard.
Upon initial licensing the backyard was not completed and needed a lot of work to bring it up par to have children outside and able to utilize it in a safe manner.

The backyard has recently been redone and turf was put in, fences were put up to keep children in a specific area of the yard, with adequate play equipment that is safe for children and is age appropriate. The backyard poses no safety concerns. Half of the yard will remain off limits and is properly barricaded with no access to it by the children in care.

Licensees are providing 100% supervision while children are outside.

While here LPA toured the yard and the inside of the house, as work had been completed since initial licensing. During the visit there were 8 children present with the spouse and the licensee.

LPA did confirm CPR certificate was valid and discussed the safe sleep regulations, infant sleep logs and infant sleep plans with the licensee. LPA also verified that licensing forms were kept for all children including the children of the licensees.

As of today June 16th, 2022, LPA has confirmed the backyard is set up in a safe manner.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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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