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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408589
Report Date: 05/11/2021
Date Signed: 05/11/2021 01:44:02 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:ROBINSON, SHLANDAFACILITY NUMBER:
073408589
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
05/11/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:SHLANDA ROBINSONTIME COMPLETED:
12:00 PM
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10:00AM, Licensing Program Analyst Tasha Alexander met with licensee Shlanda Robinson for an announced INCREASE OF CAPACITY inspection. Present for the inspection were licensee, and her 4 children. LPA toured the facility and backyard for a health and safety inspection. The children's files was not reviewed today. The home is equipped with a 3A40BC fire extinguisher, working smoke detector and working carbon monoxide detector. There is a working telephone in the home. Per licensee there are no firearms is located on the premises. There are no pools, hot tubs, or other bodies of water at the home. All poisons, cleaning solutions and medications are inaccessible to children. Licensee has current CPR and 1st Aid training which includes nutrition and lead poisoning training, expires 5/2023 respectively. The off limits areas are the entire upstairs, downstairs bedroom, laundry room and garage. These areas will be inaccessible by closed doors, visual supervision and a safety gate at the bottom of the stairs. Licensee was also informed of the licensing web address (www.ccld.ca.gov) for downloading child care forms and (www.myccl.com) to register to receive child care updates.
A review of staff records on 5/2023 indicates that all facility staff or other individual who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.


Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been vaccinated against pertussis, measles and influenza or has an exemption. Today licensee has immunization records in file and all are up to date.

The newly implemented mandatory mandated reporter training course was also discussed today. Licensee has a certificate of completion in file dated 3/2021.

CONTINUED ON 809-C

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021
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 2
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: ROBINSON, SHLANDA
FACILITY NUMBER: 073408589
VISIT DATE: 05/11/2021
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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.htm

ALL COVID-19 POSTINGS WERE OBSERVED AND POSTED. THE SELF-ASSESSMENT GUIDE HAS ALSO BEEN RECEIVED AND IS IN FILE.

As a result of this visit, there are no deficiencies cited today. This report must be available for public review for 3 years. An exit interview was conducted.



THIS HOME WILL BE LICENSED FOR A LARGE FAMILY CHILD CARE HOME EFFECTIVE TODAY 5/11/21.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021
LIC809 (FAS) - (06/04)
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