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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407848
Report Date: 10/29/2019
Date Signed: 10/29/2019 03:34:11 PM

COMPREHENSIVE INSPECTION
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:SHAW-POSEY, ZANIAFACILITY NUMBER:
073407848
ADMINISTRATOR:SHAW-POSEY, ZANIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 307-6689
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:14CENSUS: 8DATE:
10/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Marjorie Darcey/Zania Shaw-PoseyTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced random annual site inspection for this facility on 10/29/19 at 1:50 PM. Upon arrival LPA met licensee's mother, Marjorie Dansby, and there were four children in care consisting of two infants and two preschoolers. Also present was licensee's recently turned 18 year old son. LPA began a health and safety inspection of all areas of the facility on limits to children in care. Licensee arrived with four school age children in care at approximately 2:25 PM. The facility is within ratio and capacity.

The on limits to children in care areas of the home are the living room and dining area, the hall bathroom and the converted garage. The converted garage is not to be used for children napping. There are no hazardous items/toxins observed to be accessible to children. Per licensee, there are no firearms stored or present on the premises.

The backyard/outdoor area is off limits to children at this time. For outdoor play the facility will use the local park. There are no pools, hot tubs or other bodies of water accessible to children in care.

There is a working smoke detector, working carbon monoxide detector and fully charged fire extinguisher. All required postings are present including parents' rights and facility license.

LPA reviewed the facility, staff and children's records including parents' rights forms, emergency ID forms and immunization records. Licensee has current CPR/First Aid which expires 02/23/21. Licensee's mother does not have current CPR/First Aid certification.

Continued on Page 2*************************************************************************************
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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 3
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: SHAW-POSEY, ZANIA
FACILITY NUMBER: 073407848
VISIT DATE: 10/29/2019
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 Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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

The Safe Sleep Awareness Campaign PIN informational was provided and reviewed. Licensee is encouraged to visit www.ccld.ca.gov for licensing regulations and forms. To sign up for quarterly updates contact: childcareadvocatesprogram@dss.ca.gov.

LPA and licensee reviewed the current Facility Personnel Report Summary and verified that all adults requiring background clearances are cleared and associated to this facility. Licensee's 18 year old son will be submitting livescan fingerprints within 30 days.

The attached Type B deficiency was cited during this inspection. A copy of the appeal rights was provided and a notice of site visit was printed and posted and is to remain posted for a period of 30 days. A copy of this report is to be available in the facility records for three years from today's date.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SHAW-POSEY, ZANIA
FACILITY NUMBER: 073407848
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2019
Section Cited

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102416(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This facility was not in compliance with this requirement as evidenced by the presence of licensee's
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mother alone with four children in care without current CPR/First Aid certification posing a potential risk to the health and safety of the children.
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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: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3