515408419-4-11-2024-13-CC-EFRE-D48M9D-20240411092434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 515408419
Report Date: 04/11/2024
Date Signed: 04/11/2024 09:25:13 AM

Document Has Been Signed on 04/11/2024 09:25 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	MEADOWS, STACEY FAMILY CHILD CARE HOME		FACILITY NUMBER:	515408419
ADMINISTRATOR/ DIRECTOR:	MEADOWS, STACEY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 701-4766
CITY:	YUBA CITY	STATE: CA	ZIP CODE:	95991
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	04/11/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Stacey Meadows		TIME VISIT/ INSPECTION COMPLETED:	09:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A prelicensing inspection was conducted today at 8:00am by Licensing Program Analyst (LPA), Elizabeth Friese. LPA met with applicant Stacey Meadows. The applicant is requesting a license for a capacity of 14. The facility will operate Monday-Friday, 7:00am to 6:00pm. The residence is a 3 bedroom/2 bath single story home. There are 2 adults and 0 minors currently living in the home. The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: the laundry room, garage, master and second bedroom, kitchen and locked storage shed. These areas have been made inaccessible by means of door knob covers, keyed locks and baby gate. Poisons are locked in the outdoor shed. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The gas fireplace is securely screened with glass, metal screen and the gas switch will be made inaccessible by plastic switch cover. The children will use the backyard as the outdoor play area. The backyard is completely fenced. The applicant intends to make a parking area in the yard inaccessible, and understands that constant supervision will be necessary to keep children out of the area in the meantime. There is no pool, spa, pond, fountain, or any other body of water on the premises.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Elizabeth Friese
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MEADOWS, STACEY FAMILY CHILD CARE HOME	FACILITY NUMBER: 515408419
	VISIT DATE: 04/11/2024

NARRATIVE

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Because the applicant rents the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) 514-0301 (voice) or (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

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Elizabeth Friese
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MEADOWS, STACEY FAMILY CHILD CARE HOME	FACILITY NUMBER: 515408419
	VISIT DATE: 04/11/2024

NARRATIVE

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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

On 2/20/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Elizabeth Friese
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: MEADOWS, STACEY FAMILY CHILD CARE HOME	FACILITY NUMBER: 515408419
	VISIT DATE: 04/11/2024

NARRATIVE

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Exit interview conducted and report was reviewed with the applicant Stacey Meadows.
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The following items need to be completed prior to the granting of license:

1. Switch cover for fireplace switch
2. Photos of ammunition locked separately from firearms
3. Transfer of criminal clearance for assistant

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Elizabeth Friese
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC809 (FAS) - (06/04)

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