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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412740
Report Date: 09/15/2022
Date Signed: 09/15/2022 01:15:26 PM


Document Has Been Signed on 09/15/2022 01:15 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:SHEPHERD FAMILY CHILD CAREFACILITY NUMBER:
197412740
ADMINISTRATOR:SHEPHERD, DARNISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 718-2652
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 14DATE:
09/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Darnisha Shepherd, LicenseeTIME COMPLETED:
01:20 PM
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On 09/15/22, Licensing Program Analysts (LPAs) Justeene Tamayo and Andrew Alemoh met with Licensee, Darnisha Shepherd, who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 4 bedroom, 2.5 bathroom home with kitchen/dining, family room, living room, laundry room and garage. There is a pool/spa or body of water on the premises. Upon arrival LPA observed 14 children in care, along with two assistants. Family members residing in the home include 2 adults (licensee and licensee's husband) and two minor children. Facility operation are Monday-Friday 7AM-5PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room. Children use the bathroom in hallway on the left. Children have access to the living room and family room. Off limit areas include all bedrooms, bathrooms (#2 and a half), laundry room, and garage. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink with safety latch), medicines (master bedroom with door lock) and hazardous items (sharp knives in upper kitchen pantry unreachable to children in care) that can pose a danger to children. LPAs observed the fireplace to be screened. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector, Fire Extinguisher (3A40BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in bedroom #1. LPAs observed a firearm and ammunition stored separately in safe (off limits area) following Title 22 regulations. The facility sketch is complete and current, there is working telephone (cell).
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SHEPHERD FAMILY CHILD CARE
FACILITY NUMBER: 197412740
VISIT DATE: 09/15/2022
NARRATIVE
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Fire/Disaster Drill is complete and maintained current. Last Fire/Disaster drill was completed on 09/13/2022.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPAs did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are under kitchen sink with safety latch. Breakfast, lunch and snacks are provided. Naps are provided on cots in main care area.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). LPAs observed the in ground swimming pool to be fully barricaded with self latch gate over 5 Ft high, pulling away from the swimming pool. There is an outdoor air conditioner inaccessible to children with barricaded gate. The swimming pool observed follows Title 22 regulations. LPAs observed age appropriate toys. Per licensee, there is one dog on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expired on 06/15/2021. LPAs reminded licensee, CPR/First aid must be completed every two years. Facility has been cited a Type B Citation, please see LIC809-D. Mandated Reporter expired on 11/23/2020. Licensee will retake her mandated reporter training and send proof of completion to LPA Tamayo no later than 09/19/22. There are no window cords accessible to children.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SHEPHERD FAMILY CHILD CARE
FACILITY NUMBER: 197412740
VISIT DATE: 09/15/2022
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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227) and Emergency Disaster Plan. Licensee stated currently does not have child care insurance.

Licensee Shepherd 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.

LPAs discussed the safe sleep regulations with licensee Shepherd and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Darnisha Shepherd along with her appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 09/15/2022 01:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: SHEPHERD FAMILY CHILD CARE
FACILITY NUMBER: 197412740

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,interview,record review, the licensee did not comply with the section cited above. LPAs observed licensee's First Aid/CPR expired on 06/15/2021, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2022
Plan of Correction
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Licensee will enroll in CPR/First Aid class in person and send proof of completion to LPA Tamayo no later than 11/15/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
LIC809 (FAS) - (06/04)
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