013421301-7-22-2019-02-CC-SNEN-BEBUMB-20190722154204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421301
Report Date: 07/22/2019
Date Signed: 07/22/2019 03:42:09 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SHEEN, CATRINA		FACILITY NUMBER:	013421301
ADMINISTRATOR:	SHEEN, CATRINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 213-9509
CITY:	ALBANY	STATE: CA	ZIP CODE:	94706
CAPACITY:	14	CENSUS: 6	DATE:	07/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Catrina Sheen		TIME COMPLETED:	04:00 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 site visit was conducted by LPA Susan Neeson. Met with Catrina Sheen, Licensee and her husband. Visit began at 1:30 PM. She resides here with her husband and school age child.. There are 5 adults fingerprint clear and associated with the facility. There are 6 children present, all are preschool age.. CPR and First Aid are current for Catrina and Jason Sheen. The home has two bedrooms and two baths. Day care is done in living room, kitchen and new addition. The entire upstairs is off-limits. There is a secure barricade on the stairs. The home has central heating and no fireplace. The new room has a wall heater with a secure barricader. There are adequate toys and equipment for the children in care. All hazardous items are locked up or stored up high and inaccessible to children. The fire extinguisher is currently charged and smoke alarm works. There is a carbon monoxide detector. Outlets are covered. The family has two cats who stay in the master bedroom during hours of child care.. There are no bodies of water. Fire/earthquake drills are being documented. Required forms are posted. Children's records are being maintained. Roster is current. The new addition was inspected and it is ready to be used by children. The yard was also inspected and can be used by children/ Jason Sheen states that there are no guns or firearms in the home or storage area. Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov and for day care updates visit www.myccl.gov.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan Neeson	TELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

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: SHEEN, CATRINA	FACILITY NUMBER: 013421301
	VISIT DATE: 07/22/2019

NARRATIVE

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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.htmMedical Services were discussed with Catrina Sheen. She stated that IMS is not being done at the day care at present.

The following documents were issued: Safe Sleep concepts for infants, Safe and healthy diapering, blue immunization form, car seat information, Licensee rights, fire/earthquake drill forms, Department Quarterly Updates for Winter and Spring 2019 and Flu prevention tips.

No deficiencies are observed. An exit interview was given.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan Neeson	TELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019

LIC809 (FAS) - (06/04)

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