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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411075
Report Date: 07/19/2019
Date Signed: 07/19/2019 03:08:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SHORT, MISTI & BRIANFACILITY NUMBER:
013411075
ADMINISTRATOR:SHORT, MISTIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 276-5220
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY:14CENSUS: 11DATE:
07/19/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:SHORT, MISTITIME COMPLETED:
03:30 PM
NARRATIVE
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On 07/19/2019 at approximately 10:50am, Licensing Program Analysts Chew and Guirit, conducted an Unannounced Proof of Correction (POC) site inspection. Present during the inspection was the licensee 14 years old daughter, her fingerprint daughter Katrina Short Almeida, and 11 children which consisted of the following: 3 infants, 5 preschoolers and 3 School age children.

During an Annual Random inspection conducted on 05/23/2019, the licensee was cited for failure to complete the required AB1207 Mandated Reporter Child Care Training course.

During today's Proof of Correction inspection licensees Misti Short, advised she and her husband Brian Short, have not completed the required Mandated Reporter training. Licensees are being recited for failure to complete the required training.

Licensee was reminded failure to correct deficiency will result in a $100.00 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100.00 per day until corrected.

Appeal Rights were provided. Exit interview was conducted with Misti Short, See attached 809D for deficiency cited.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha ChewTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SHORT, MISTI & BRIAN
FACILITY NUMBER: 013411075
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2019
Section Cited
HSC
1596.8662(b)(1
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1596.8662 Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
REQUIREMENT WAS NOT MET: LICENSEE HAS NOT COMPLETED THE MANDATED REPORTER TRAINING COURSE.
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LICENSEE WILL COMPLETE THE MANDATED REPORTER TRAINING COURSE AND SUBMIT THE CERTIFICATE OF COMPLETION TO COMMUNITY CARE LICENSING BY (GIVE 30 Days.)

Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250.00 per violation and $100 per day until corrected.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha ChewTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC809 (FAS) - (06/04)
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