153909883-12-13-2021-04-CC-CHAS-C9NS22-20211213122848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153909883
Report Date: 12/13/2021
Date Signed: 12/13/2021 12:29:00 PM

Document Has Been Signed on 12/13/2021 12:29 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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	SIMS, SHAINA & JAMILAH FAMILY CHILD CARE		FACILITY NUMBER:	153909883
ADMINISTRATOR:	SIMS, SHAINA & JAMILAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 548-0072
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93314
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 13	DATE:	12/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Shaina & Jamilah Sims		TIME COMPLETED:	01:00 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	On 12/13/2021 Licensing Program Analyst, (LPA) Caroline Harris conducted an unannounced annual inspection. LPA met with Licensee's, Shaina & Jamilah Sims. LPA conducted a tour of the home, inside and outside, as shown on the facility sketches (LIC 999A) provided. The LPA observed all required licensing forms to be posted in a visible location for authorized representatives to view them. A census was taken and there were thirteen day care children present. The LPA observed the licensee to have one dog and three cats. The pets are indoor/outdoor. The licensee's are aware of the safety of children around animals and takes responsibility for any action taken by their pets. The LPA observed inaccessible rooms to be off limits to children by the use of door knob spinners and locks. The accessible rooms are the living room, dinning room, kitchen, hall bathroom, converted garage and front bedroom. The fenced back yard is also accessible. Licensee is aware that children are to be supervised when outside an unfenced play area. There are no swimming pools or other bodies of water on the premises. The LPA observed safe toys and play equipment both indoors and outside. There were no poisons observed on the premises accessible to children. Licensee is aware that poisons are required to be locked and inaccessible to children. Cleaning compounds, medications and other hazardous items were inaccessible to children. There are no firearms or ammunition present at this facility. There is no fireplace. There is a working fire extinguisher, smoke detector, carbon monoxide indicator, and adequate heating and ventilation for safety and comfort. The licensee has a complete first aid kit, including bandages, scissor, thermometer, gloves and a first aid manual. There are no stairs in the home. There is a working telephone and the above telephone number was verified. Adequate supervision is being provided during this visit. Capacity as specified on the license is being maintained. LPA reviewed six children’s files. Two out of six files reviewed did not have a copy of Family Child Care Home Notification of Parent's Rights (LIC 995A). Licensee did maintain documentation of immunizations for the children.

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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: SIMS, SHAINA & JAMILAH FAMILY CHILD CARE	FACILITY NUMBER: 153909883
	VISIT DATE: 12/13/2021

NARRATIVE

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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are found (see next page): 809 D

An exit interview was conducted and a copy of this report, along with appeal rights was provided to the licensee's, Shaina & Jamilah Sims and was reviewed. This report shall be made available to the public upon request. The LIC 9213 Notice of Site Visit form was provided to the licensee and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/13/2021 12:29 PM - It Cannot Be Edited

Created By: Caroline Harris On 12/13/2021 at 11:52 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: SIMS, SHAINA & JAMILAH FAMILY CHILD CARE	FACILITY NUMBER: 153909883
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	This requirement was not met as evidenced by the licensee's not having updated Mandated Reporter training's as they expired. This poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 12/27/2021
	Plan of Correction
1 2 3 4	The licensee's agree to complete the Mandated Reporter training by the due date of 12/27/2021, and send copies of the certifications to the LPA.

Type B

Section Cited

CCR

102419(d)

Admission Procedures and Parental and Authorized Representative's Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the LPA observed two of the six files reviewed not to have notification of parent rights. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/20/2021
	Plan of Correction
1 2 3 4	The licensee's agree to provide a copy of Parent Rights form to the required parent and get the signed receipt. A copy of the receipt will be sent to the LPA by the due date of 12/20/21.

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:

Alice Juarez

LICENSING EVALUATOR NAME:

Caroline Harris

LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

LIC809 (FAS) - (06/04)

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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: SIMS, SHAINA & JAMILAH FAMILY CHILD CARE	FACILITY NUMBER: 153909883
	VISIT DATE: 12/13/2021

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 Section 102417. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services.

Fire drills are conducted and documented with the date, time and how many children present, every six months. Licensee is aware that children are never to be left in parked vehicles. 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. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Licensee is aware that upon notice from the Department, any excluded individual must be immediately removed from the home and prevented from returning to the home or having contact with children in care. Licensee is aware that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice. Pediatric CPR/First Aid are current and expire on 4/17/2023. Licensee does not maintain documentation of immunizations against pertussis, measles or influenza for herself or staff, but copies are in the office file. Days and hours of operation are Monday – Friday; 7;30 AM – 6:00 PM.

An exit interview was conducted with the Licensee. LPA reviewed with licensee the Mandated Child Abuse Reporter Training (AB 1207), which the licensee has not updated as it expired. It is required to be updated every two years. There are currently no infants in care. The LPA and licensee discussed the Community Care Licensing website: www.ccld.ca.gov. which provides access to Provider Information Notifications (PINS), Quarterly Updates that inform licensees of new legislation and regulations, trainings, and Licensing forms and updated information. The licensee was also advised that it is her responsibility to stay current with regulations.

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021

LIC809 (FAS) - (06/04)

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