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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911188
Report Date: 07/20/2021
Date Signed: 07/20/2021 05:16:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:VITAL, SHAWNA FAMILY CHILD CAREFACILITY NUMBER:
103911188
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
07/20/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Shawna VitalTIME COMPLETED:
05:30 PM
NARRATIVE
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On July 20, 2021, Licensing Program Analysts (LPA)s, Norma Lomeli and Araceli Gibson conducted a capacity increase inspection from a Small Family Child Care Home to a Large Family Child Care Home. Present at time of inspection was licensee, licensee’s assistant, licensee’s minor daughter and four day care children who were napping. Licensee, her husband and two minor children reside in the home. Verified licensee CPR and First Aid was completed through Pediatric Plus with Emergency Medical Services Authority stickers (EMSA) and expires on February 1, 2022. Licensee’s Assistant, Mikayla Vital does not have Pediatric CPR and First Aid, applicant understands that she will not be left alone to care and supervise the children in care. Background criminal record clearances are verified and discussed, and LIS 531 is signed indicating that the adults living in the home and/or providing care and supervision to children have a criminal record clearance. Fire clearance was granted on April 30, 2021.

A tour of the home, inside and outside, as shown on the facility sketch, was conducted and the following was discussed and/or observed:
  • Fire clearance was received on July 15, 2021. Fire alarm is located on the home’s entry wall on the left hand side wall.
  • LPA observed children size furniture, safe toys and books for the children. LPAs also observed a slide/swing play structure, a play house, a Little Tikes basketball hoop and tricycles in the outdoor play area.
  • Licensee states she does not have weapons, firearms, ammunition or poisons in the home.
(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: VITAL, SHAWNA FAMILY CHILD CARE
FACILITY NUMBER: 103911188
VISIT DATE: 07/20/2021
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  • Facility has 3A40BC fire extinguisher, carbon monoxide alarm, working smoke alarm and first aid kit in place.
  • Licensee is advised at least one staff member with current training in pediatric first aid and pediatric CPR is to be on site at all times children are present.
  • Licensee is advised that smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a). Licensee states the home is smoke-free.
  • Licensee states she will not be transporting day care children. Licensee understands that she must have proper restraints and/or car seats for all the children under her care when transporting children.
  • Required items are posted in the Child Care Home where parents may easily view.
  • During visit capacity worksheet was provided and discussed.
  • Licensee completed the Mandated Reporter Training on August 23, 2019. Licensee’s Assistant completed the training on March 6, 2020.
  • LPA discussed safe sleep pending regulations and Safe Sleep Regulation Concepts were given licensee.

LPA & licensee discussed the Community Care Licensing website: LPA and licensee discussed new additions to the website that include the new PIN (Provider Information Notification) and information for providers including the Quarterly Update that informs licensees of new legislation and regulations. Please follow these steps go to http://www.cdss.ca.gov/, click on “information and resources” click “Community Care Licensing” Click “quarterly updates” click “Child Care advocates program” and register to PIN.

Licensee states her hours of operation are Monday through Friday from 7:45 AM to 5:30 PM and as arranged. Licensee advised she does not provide overnight care, less than 24 hours. Licensee is advised she may access forms and updated information on the CCLD website at www.ccld.ca.gov.

(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: VITAL, SHAWNA FAMILY CHILD CARE
FACILITY NUMBER: 103911188
VISIT DATE: 07/20/2021
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Licensee is advised the following item must be corrected and documentation be sent to CCL within the next 30 days to avoid possible withdraw.
  • Licensee’s assistant will complete the Mandated Reporter Training.


Pending verification of correction of the above items and a final review of her application, licensure as a Large Family Day Care Home capacity of 14 children ages under 18 years will be recommended

During exit interview, LPA observed licensee post the Notice of Site Visit on parent’s board and understands it must remain posted for 30 days and retain evaluation report for 3 years.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)650-7870
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
LIC809 (FAS) - (06/04)
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