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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909883
Report Date: 10/15/2021
Date Signed: 10/15/2021 10:23:38 AM

Document Has Been Signed on 10/15/2021 10:23 AM - 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 CAREFACILITY NUMBER:
153909883
ADMINISTRATOR:SIMS, SHAINA & JAMILAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 548-0072
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
10/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jamiliah & Shaina SimsTIME COMPLETED:
11:00 AM
NARRATIVE
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On 10/15/21 Licensing Program Analyst (LPA) Caroline Harris conducted a case management inspection. The purpose of this inspection is to discuss a violation which was discovered during the complaint investigation.

Upon review of communication between a parent and the licensee's, the licensee admitted to swaddling an infant in care while they were sleeping. The LPA also observed a picture of the infant sleeping on a blanket in the play yard.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, are being cited on the attached LIC 9099D. "Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months." Child Care Parent Notification Requirements LIC 9224 was provided and discussed (LIC 9224 -Acknowledgement of Receipt of Licensing Reports).

An exit interview was conducted with Shaina & Jamilah Sims. A copy of this report and appeal rights were provided. A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Caroline Harris
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2021
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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Document Has Been Signed on 10/15/2021 10:23 AM - It Cannot Be Edited


Created By: Caroline Harris On 09/30/2021 at 12:07 PM
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: 10/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/29/2021
Section Cited
CCR
102425(a)(b)(3)

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INFANT SAFE SLEEP. Cribs or play yards shall be free from all loose articles and objects. Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the
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The licensee agrees to attend a training on Safe Sleep Regulations
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mattress so it cannot be dislodged. This requirement was not met as evidenced by the LPA observing an infant asleep in a play yard on top of a blanket. This is an immediate risk to the health, safety or personal rights of children in care.
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Type A
10/29/2021
Section Cited
CCR102425(f)

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An infant shall not be swaddled while in care. This requirement was not met as evidenced by the LPA observing a picture that was sent to a parent by the licensee stating, "unswaddled" after the parent questioned the licensee.
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This is an immediate risk to the health, safety or personal rights of children in care.
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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: 10/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2021


LIC809 (FAS) - (06/04)
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