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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 214005217
Report Date: 05/09/2019
Date Signed: 05/09/2019 08:14:33 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ZOILA-SHAFFER, MICHELLE E.FACILITY NUMBER:
214005217
ADMINISTRATOR:ZOILA-SHAFFER, MICHELLE E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 453-3919
CITY:ROSSSTATE: CAZIP CODE:
94957
CAPACITY:14CENSUS: 10DATE:
05/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Michelle Zoila-ShafferTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Farhan Bashir-Tariq met with the Licensee Michelle Zoila-Shaffer to conduct an Annual Random Inspection on 5/9/19. The purpose of the visit was explained. Present there were 10 children (all preschool age) in care with the Licensee and a helper . Licensee is operating within the capacity and ratio limits as of today 5/9/19.
LPA observed that there is a pool in the backyard. LPA observed that the fence has been installed to prevent access to the pool. Per Licensee, there are no firearms or weapons in the home. All cleaning supplies or items that can be harmful to children are out of reach. There is a fireplace in the home that is screened and not used during day care operation. The home is ventilated appropriately and is at a comfortable temperature. There is a fully charged fire extinguisher that meets regulation requirements. The home has a working smoke and carbon monoxide detector in multiple places. There is a variety of age appropriate toys and learning equipment available to the children. Discipline policy is redirection and talking with children. The outdoor play areas are appropriately fenced for supervision and all toys are in good condition. The Licensee has a current roster of children in care. All children's files contained signed parents’ rights forms and Immunization records. Licensee has the completion certificate of preventive health and safety training. Licensee conducts fire drills every 6 months and logs them. The last fire drill was performed on 1/17/19. Licensee has a valid First Aid and CPR card which expires on 3/2020. LPA reminds the Licensee that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA observed the record of immunization of each present helper.
As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.
LPA encourage the facility to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.
>No deficiencies were issued today under Title 22 Division 12 of the California Code of Regulations.
>This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Notice of site visit shall be posted for 30 days from today's visit. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800 . For Rules and Regulations, visit the Website: www.cdss.ca.gov
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8867
LICENSING EVALUATOR NAME: Farhan Bashir-TariqTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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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