073406216-5-10-2019-02-CC-CCHS-BC2MYP-20190510100153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406216
Report Date: 05/10/2019
Date Signed: 05/10/2019 10:02:28 AM

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:	NIEMEIER, SHANON		FACILITY NUMBER:	073406216
ADMINISTRATOR:	NIEMEIER, SHANON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 595-1282
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	14	CENSUS: 10	DATE:	05/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Shanon Niemier		TIME COMPLETED:	10:30 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	05/10/2019, at 9:00 am LPA's Chandra Charles and Diana Campos met with licensee Shanon Niemeier, for the purpose of an unannounced annual random inspection. Present during the inspection were Assistants Rhonda Carmignani and Kathleen Pedreira who have a fingerprint clearance and 10 preschool children. LPA's inspected the on limit areas of the home for a health and safety check (inside and out.) The off limit areas remains as licensed. Licensee runs her family home day-care like a preschool center and has four classes, 2 sessions per day. There are ample age appropriate toys and school materials that are in safe and in good condition. The home is equipped with a working smoke detector, working carbon monoxide detector, working telephone, a fully charged 4A80BC fire extinguisher, pull down fire alarm device and fully stock first aid kits. There is a fire arm in the home stored in the Master Bedroom which is off limits and the ammunition is stored separately in the garage. (2) Children facility files were reviewed and found to be in compliance with the Title 22 regulations. Licensee and her Assistants are in compliance with the immunization law for day care providers. The outdoor play area is fenced and free from defects or dangerous conditions. There are no pools, hot tubs or any other bodies of water on the premises. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. Licensee has a stair gate in place preventing access to the second level of the home which remains off limits. Current facility roster and fire/disaster drill log, was made available for review. Licensee's & Assistant's CPR/First aid certificates were reviewed and are current expiring 03/2021. Licensee conducts Fire/Disaster drills with the last one being conducted and recorded as of April 8, 2019.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Chandra Charles	TELEPHONE: (510) 725-7529
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

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: NIEMEIER, SHANON	FACILITY NUMBER: 073406216
	VISIT DATE: 05/10/2019

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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

Incidental Medical Services (IMS) was discussed. The following information regarding ADA was provided to licensee… US DOJ toll free ADA Information Line (800) 514-0301 and the link to FAQ about child care and ADA http://www.ada.gov/childqanda.htm
LPA discussed the requirement to create a plan of operation when needed. Specifics on the plan can be found in the family child care home evaluator manual (FCCH EM) Policy 102417.

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with licensee.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Chandra Charles	TELEPHONE: (510) 725-7529
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

LIC809 (FAS) - (06/04)

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