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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408778
Report Date: 12/14/2022
Date Signed: 12/14/2022 04:46:41 PM


Document Has Been Signed on 12/14/2022 04:46 PM - It Cannot Be Edited

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:WHITE, SHANNONFACILITY NUMBER:
073408778
ADMINISTRATOR:WHITE, SHANNONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 435-5365
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:14CENSUS: 4DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Shannon WhiteTIME COMPLETED:
04:47 PM
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On 12/14/22 at 2:20PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Annual inspection at Shannon White Family Childcare Home. LPA met with Shannon and explained the purpose of today's inspection. LPA were granted the inspection authority to enter the Home. The family childcare home days and hours are Monday to Friday 7:30 AM to 5:30 PM. Present in the home at time of inspection were licensee, licensee's son, licensee's mother, 1 infant, 1 preschool and 2 school-age children.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Indoor Space: A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 2A10BC fire extinguisher, smoke and carbon monoxide detector in the home.



The OFF-LIMIT areas are daughter's bedroom and garage. These areas are inaccessible to children in care by closed locked doors and safety gates. IN-USE the living room, master bedroom/bath, mother's bedroom and hall bathroom are used as the primary areas for day-care. Medicines, cleaning products, sharp objects are stored inaccessible to children. LPA reminded licensee that baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are 3 dogs and no arms and ammunition stored in the home. The fireplace is screened, and the home maintains a working telephone.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022
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 4


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: WHITE, SHANNON
FACILITY NUMBER: 073408778
VISIT DATE: 12/14/2022
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Outdoor Space: LPA toured the outdoor area (backyard) and observed it was fenced. LPA observed there is a pool surrounded by 5 foot fence. LPA observed the gate swings away from the pool and self close with a latch.

Children files and Facility files were reviewed. Facility contained Children's Roster, Licensee’s mandated reporter training expires 12/16/23, pediatric CPR and first aid expires 1/13/24.

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

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

There were no deficiencies cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Shannon White.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC809 (FAS) - (06/04)
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