198014088-4-13-2023-54-CC-SSAZ-CQUQV2-20230413122936

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014088
Report Date: 04/13/2023
Date Signed: 04/13/2023 12:29:50 PM

Document Has Been Signed on 04/13/2023 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	SHACK FAMILY CHILD CARE		FACILITY NUMBER:	198014088
ADMINISTRATOR:	SHACK, FELICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 639-3443
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	14	CENSUS: 0	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Felicia Shack, Licensee		TIME COMPLETED:	12:50 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 April 13, 2023 at 11:00 AM, Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced inspection at the facility noted above and met with Facility Representative (FR) Bobby Lyons. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 7:00 AM to 6:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. Per Licensee has not had any children enrolled since before COVID. Licensee states that they still want to be active and do not wish to go inactive. This is a two-story home which consists of 4 bedrooms, 4 bathrooms, kitchen, dining room, living room, office, preschool room, backyard, garage and front yard. The children use the bathroom that is connected to the pre-school room. Per licensee, areas off limits to children and parents include: all upstairs, all bedrooms, garage, kitchen, dining room, living room , and 3 restroom and front yard. The licensee provides food for children in care. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises. The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), and Facility Roster (LIC 9040). Licensee has an Emergency Disaster Plan (LIC 610A) available for review. Licensee was advised that Disaster and Fire Drills must be conducted at least once every six months, and the Licensee shall document the date and time of each drill for review.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SHACK FAMILY CHILD CARE	FACILITY NUMBER: 198014088
	VISIT DATE: 04/13/2023

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
26
27
28
29
30
31
32

Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home does not have any wall heaters or fireplaces. The home is equipped with central air and heating. Detergents, cleaning compounds, and medicines were made inaccessible to children. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock.

Per Licensee, there are no pets in the home. LPA observed age appropriate toys and napping equipment for children. LPA also observed electrical outlet covers installed in the child care areas. Per Licensee, snacks and meals are provided to the children by the facility. Licensee was reminded that any food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA observed the required fire extinguisher (2-A:10-B:C or larger) that is fully charged. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detector and carbon monoxide detector were tested and are operable. First Aid kit and emergency supplies are available.

Based on record review, Licensee has proof of immunization against measles, pertussis, influenza, and a TB clearance. Licensee has a current Pediatric First Aid and CPR certification (expires 05/2023). Licensee completed the Mandated Reporter Training (AB 1207) on July 05. 2022. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.

Currently licensee is does not want. LPA review the following just in case Licensee changes her mindl: napping equipment should not block entrances or exits. Infant mattresses should be firm with tightly fitted sheets. Loose object, bumpers, objects hanging, or objects attached to the cribs/play yards are not allowed. LPA discussed the safe sleep regulations with Licensee 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. LPA 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SHACK FAMILY CHILD CARE	FACILITY NUMBER: 198014088
	VISIT DATE: 04/13/2023

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platforms.

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/inspection-process.

No deficiencies were cited during today's inspection. A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Appeal Rights were given and explain. Exit interview conducted and report was reviewed with Licensee, F. Shack.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3