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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153909883
Report Date: 08/09/2021
Date Signed: 08/09/2021 12:19:56 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: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:14CENSUS: 13DATE:
08/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shaina & Jamilah SimsTIME COMPLETED:
12:30 PM
NARRATIVE
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On 8/9/21 Licensing Program Analysts (LPAs) Caroline Harris and Jessika Thompson conducted a case management inspection. The purpose of this report is to cite a violation which was discovered during the inspection.

Upon review of children's files, the licensee's did not have prior Acknowledgement forms for type A violation's, in twelve children's files.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, are being cited on the attached LIC 9099D. 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.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/16/2021
Section Cited

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Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services. A licensed child day care facility shall provide to the parents or guardians of
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each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.
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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 JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Caroline HarrisTELEPHONE: (559) 341-4624
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2021
LIC809 (FAS) - (06/04)
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