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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293626319
Report Date: 12/23/2024
Date Signed: 12/23/2024 02:06:44 PM

Document Has Been Signed on 12/23/2024 02:06 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LITTLE BLOOMS PRESCHOOL & CHILDCAREFACILITY NUMBER:
293626319
ADMINISTRATOR/
DIRECTOR:		DEPEW, AMANDAFACILITY TYPE:
860
ADDRESS:13195 RIDGE RDTELEPHONE:
(530) 559-6724
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
12/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Amanda DepewTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Applicant Amanda Depew for the purpose of a pre-licensing inspection. Applicant requests a toddler component to serve 5 toddlers ages 18-36 months and preschool component for 15 children ages two years to entry into kindergarten for a total capacity of 20. The program will operate Monday through Friday from 7:00 a.m. to 6:00 p.m. The fire clearance was granted and received on 11/8/2024. The facility will provide breakfast, lunch, and afternoon snacks.

LPA reviewed with Applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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-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.

INDOOR ACTIVITY SPACE:
There is one toddler classroom, one preschool classroom, and a multipurpose room. LPA observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. Applicant stated first aid kit will be located in the upper kitchen cupboard. Medications will be stored in the kitchen above the fridge. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. Applicant stated the facility will provide water pitcher/water bottles for the children through out the day. LPA observed a functional carbon monoxide detector near the front door and the MPR. LPA observed an electronic sign-in/sign-out system.

Report continue on LIC809-C page 2.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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 4
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: LITTLE BLOOMS PRESCHOOL & CHILDCARE
FACILITY NUMBER: 293626319
VISIT DATE: 12/23/2024
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Page 2.

LPA measured the toddler classroom (room #1). The total classroom space contains a total of 181 square feet, which will accommodate Applicant's request for 5 toddlers. LPA measured the preschool classroom (room #2) and multipurpose room (MPR). The total classroom spaces contain a total of 525 square feet, which will accommodate Applicant's request for 15 preschool children. There are two toilets and three sinks for the children, and a separate private restroom for the staff located in the hallway. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the MPR and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property, Toddler & Preschool Yard. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. LPA observed some larger gaps under the some of the fencing areas. Applicant stated that they will add additional bark to level out the ground/gaps. The toddler area is located on the left bark side and the preschool area is located on the right cemented side. Applicant will utilize a temporary barrier to separate the components during outside activities. LPA observed a sufficient amount of equipment and toys. There is no play structure play structure and no bodies of water on the premises. There are shaded areas supplied by trees.

LPA measured the outdoor activity space. The toddler outdoor play area contains a total of 1,219 square feet, which will accommodate Applicant's request for 5 toddlers. The preschool outdoor play area contains a total of 1,254 square feet, which will accommodate Applicant's request for 15 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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

Report continues on LIC809-C page 3.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: LITTLE BLOOMS PRESCHOOL & CHILDCARE
FACILITY NUMBER: 293626319
VISIT DATE: 12/23/2024
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LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides 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 Child Care Center. 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.

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.

Written Directives for Lead Testing in Child Care Centers: Assembly Bill 2370, Chapter 676, Statutes of 2018, added Health and Safety Code section 1597.16 requiring all licensed Child Care Centers constructed before January 1, 2010, test their water for lead between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing. For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

Report continues on LIC809-C page 4.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LITTLE BLOOMS PRESCHOOL & CHILDCARE
FACILITY NUMBER: 293626319
VISIT DATE: 12/23/2024
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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.

Exit interview conducted and report was reviewed with the Applicant, Amanda Depew.

The following items are required before a license will be issued:

1. Final file review from Licensing Program Manager (LPM) Monica Cuddy.

2. Yard photos of completed fencing and bark.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4