013416017-5-21-2019-02-CC-PDYR-BCE2U2-20190521174136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013416017
Report Date: 05/21/2019
Date Signed: 05/21/2019 05:41:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SHELMIRE, DIANNA & PALMORE, MARK		FACILITY NUMBER:	013416017
ADMINISTRATOR:	SHELMIRE & PALMORE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 569-2078
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94605
CAPACITY:	14	CENSUS: 5	DATE:	05/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Dianna Shelmire		TIME COMPLETED:	05:45 PM

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	An unannounced Annual/Random inspection was conducted by LPA Dyer. The licensee was present with 5 day care children (school-age). Licensee was in compliance with the licensed capacity and facility ratios. Phone number is current. The day care area of the home was inspected. Areas licensed for child care: bathroom, living room, dining room, family/playroom. Off-limit areas will be made inaccessible to children by closed and/or locked doors; and visual supervision. The home was clean and orderly, with heating and ventilation. All required forms are posted and visible for public review. There was a working smoke detector (tested); a fully charged 2-A:10-B:C fire extinguisher; a first aid kit, and a carbon monoxide detector (tested). There were safe, healthful and comfortable accommodations, furnishings and equipment available to children at the time of this inspection. There were a variety of books, toys, videos and games for children's use. Fireplace was screened. There are no hazardous materials, medicines, or cleaning solutions accessible to children during this inspection. Hazardous items are kept locked in a cabinet, inaccessible to children. Licensee stated there were no firearms or bodies of water on the premises. Stairs inside the home are gated. Back yard area is securely fenced. Children play outdoors on the lower level of the yard. Licensee has toys for child play. Children have not played outside recently due to rainy weather. Last disaster drill date logged: 3/11/19. 4 of 5 children's files were reviewed at 4:05 p.m. All have emergency information in file. Facility roster was available for review. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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)/ (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. (continued)

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SHELMIRE, DIANNA & PALMORE, MARK	FACILITY NUMBER: 013416017
	VISIT DATE: 05/21/2019

NARRATIVE

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All staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee's Pediatric First aid and CPR cards expire 7/6/19. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children, or an immediate civil penalty can be assessed. A qualified assistant must be physically present whenever 9 or more children are in care. When an assistant is not present, the home reverts back to small family child care ratios.

New Regulations were discussed:
1. Adult Immunizations - Licensee has information in file.
2. Mandated Reporter Training - Licensee's Mandated Reporter Training expires 7/16/20.

Licensee was also reminded of the Department's Inspection authority, and the need to comply when notified that termination of an employee is necessary. The handout, "A Child Care Provider's Guide to Safe Sleep" was provided and discussed in detail at the last inspection and reviewed again today. Also discussed with the licensee: children in parked vehicles; fingerprinting/association; advertisements; changes in on-limit areas; and smoking. Licensee was encouraged to frequently visit the licensing website at www.ccld.ca.gov for licensing regulations, forms and updates.

For CCL Updates, e-mail: childcareadvocatesprogram@dss.ca.gov.

NO DEFICIENCIES CITED TODAY.

Notice of site visit was posted at the time of the inspection and must be posted for 30 days. An exit interview was conducted. This report must be available for public review for 3 years.

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis Dyer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

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