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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500521
Report Date: 02/04/2022
Date Signed: 02/04/2022 11:13:46 AM

Document Has Been Signed on 02/04/2022 11:13 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:NASCIMENTO, LACEYFACILITY NUMBER:
394500521
ADMINISTRATOR:NASCIMENTO, LACEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 481-5710
CITY:ESCALONSTATE: CAZIP CODE:
95320
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/04/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lacey NascimentoTIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPAs) Christopher Jackson and Lauren Scott met with the applicant Lacey Nascimento for a change of location inspection. The applicant was previous licensed at facility #394500271. This is a single story with an open front yard. There are four bedrooms and three bathrooms. The home has an open concept front room. There is a kitchen, and laundry room. In addition the home has a detached three bay car garage located to the rear of the property. The home also has an in ground pool with five foot high see through fence and no access points leading into the pool area from the home. LPAs checked the pol fence and observed it pull away form the body of water and self close and latch. The pool is secured according to title 22 regulations. There is also a hot tub in the backyard. LPAs observed the hot tub to be secured with four locks on each corner. In addition there is a locking arm bar that goes across the top. LPAs toured the home inside and out for a health and safety inspection. LPAs observed a functioning carbon monoxide detector and smoke detector. LPAs observed a fire extinguisher under the kitchen sink that meets regulation. Applicant owns the home and provided a copy of the mortgage statement for the home during today's inspection. LPAs explained the option of obtaining $300,000 liability insurance. Applicant understands that until a policy is obtained, applicant must use the affidavit. Applicant stated they have the liability insurance. LPAs received a copy of the fire clearance from the Escalon Fire Department on 01/12/22, clearing the home for a large family day care.

Report Continues on 809-C
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2022
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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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: NASCIMENTO, LACEY
FACILITY NUMBER: 394500521
VISIT DATE: 02/04/2022
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Applicant has also provided proof of Pediatric CPR and First Aid which expires on 08/2023. All adult residents received criminal record clearances. LPAs reminded applicant of the applicable Civil Penalty per person for those adults, including your own children, who have not received fingerprint clearances. LPAs provided the applicant with the web site to enable access to all updated forms, requirements and changes. The web site is (www.ccld.ca.gov). LPAs advised applicant of their responsibility to stay current in regards to new regulations. LPsA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov. Applicant understands that she needs to notify licensing for any modifications done to the home, inside and outside. LPAs observed posted Emergency Disaster Plan and Parents' Rights Poster.

Off-limit areas include bedroom #1, bedroom, bedroom #2, master bedroom, garage and backyard shed. Applicant understands that children may never enter these off-limit areas. LPAs reviewed the fire drill requirements. The fireplace contains a glass door prohibiting access by children.



Hazardous cleaning compounds and medications are stored inaccessible and or out of children's reach. The backyard is fenced in completely. Licensee understands that 100% supervision is required in any unfenced areas.

Effective today's date, 02/04/22, LPAs will approve the change of location to serve up to either 14 children, one of which must be in kindergarten and the other 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.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
LIC809 (FAS) - (06/04)
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