073408845-8-5-2021-02-CC-CACA-C5LSTE-20210805140925

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408845
Report Date: 08/05/2021
Date Signed: 08/05/2021 02:09:30 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:	BRECHEISEN, SHANNON		FACILITY NUMBER:	073408845
ADMINISTRATOR:	BRECHEISEN, SHANNON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(925) 784-2988
CITY:	BRENTWOOD	STATE: CA	ZIP CODE:	94513
CAPACITY:	14	CENSUS: 2	DATE:	08/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Shannon Brecheisen		TIME COMPLETED:	02:15 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	Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Annual Required inspection. Present during today’s inspection was the licensee, her fingerprint cleared husband and her two children. Licensee currently operates 8:30am to 11:30am Tuesday through Thursday. There were no children in care during the inspection. The home was toured for Health and Safety Inspection. On limits area consist of the living room, family room, dining room, kitchen and first floor bathroom. The remainder of the home is off limits to children. Off limits areas will be made inaccessible by use of gates, closed and/or locked doors and visual supervision. The home appears to be orderly, with heating and ventilation for safety and comfort. There are no pools, spas, hot tubs, or any other similar bodies of water at this home. Licensee has a fountain located in the backyard. The fountain does not have water. There are no firearms on the premises as stated by the licensee. Detergents, cleaning compounds, medications and other items which could pose a danger to children are stored and inaccessible to children. Stairs are gated. The home has a gas fireplace that is screened. The fireplace is not used during child care hours as stated by the licensee. LPA verified that the fire extinguisher 3A40BC is fully charged. The home is equipped with both a smoke detector and carbon monoxide detector. There is a working telephone in the home. The home provides appropriate toys, learning materials and play equipment. Outdoor play area is fenced. Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared prior to being in the presence of children or an immediate civil penalty can be assessed. Children files were reviewed. Files reviewed contain children’s emergency information. The licensee has current CPR and First Aid which expires 04/23. Mandated reporter training was completed 4/5/21. Licensee is in compliance with required immunizations for childcare providers.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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: BRECHEISEN, SHANNON	FACILITY NUMBER: 073408845
	VISIT DATE: 08/05/2021

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
26
27
28
29
30
31
32

Safe sleep regulations were discussed with the licensee.

COVID-19 safety precautions were discussed with licensee.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

Licensee was also encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

There are no deficiencies cited during today’s inspection.

An exit interview was conducted with Shannon Brecheisen.
The licensee was provided a copy of her appeal rights.
A Notice of Site visit was provided at the time of inspection and must be posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2