343618185-9-30-2021-03-CC-KFEA-C7CSSW-20210930140836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343618185
Report Date: 09/30/2021
Date Signed: 09/30/2021 02:08:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	O' SHAUGHNESSY, MARY ANNE		FACILITY NUMBER:	343618185
ADMINISTRATOR:	O' SHAUGHNESSY, MARY ANNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(916) 353-1094
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	14	CENSUS: 12	DATE:	09/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Mary Anne O'Shaughnessy		TIME COMPLETED:	02:45 PM

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On Thursday, September 30th, 2021, Licensing Program Analyst (LPA) Kelly Ferrara conducted an unannounced annual inspection and met with Licensee Mary Anne O'Shaughnessy. Licensee currently had 12 children in care with an assistant present. Facility hours of operation are Monday through Friday 7:30 AM to 4:30 PM. All adults in the home have a criminal record clearance and annual fees are current.

Off limit areas include: Entire upstairs, laundry room, garage, and right side yard. Licensee acknowledged that children may never enter these off-limit areas. LPA conducted a health and safety inspection and observed that the facility is clean, safe, sanitary, and in good repair with proper ventilation. LPA observed the proper documents were posted where visible to parents. LPA observed that there were no hazardous items accessible to children including cleaning compounds, medications, or sharp objects. LPA observed an accessible 2A-10-BC fire extinguisher. LPA observed the smoke and carbon monoxide detectors are functioning properly. The facility has adequate toys that are safe for children to use. The backyard is fenced and safe for children. LPA did not observe any bodies of water on the premises and Licensee stated there are no firearms.

LPA observed a current CPR/1st aide certificate which expires February 2022. LPA reviewed safe sleep regulations for children under age two. LPA observed the children’s roster and fire drill log are current. LPA reviewed children’s files and observed that all the required documentation was present in each child's file. LPA reviewed staff files and observed the appropriate documentation on file.

LPA discussed Incidental Medical Services- IMS with the Licensee. 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.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: O' SHAUGHNESSY, MARY ANNE	FACILITY NUMBER: 343618185
	VISIT DATE: 09/30/2021

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LPA discussed current COVID guidelines with Licensee and provided technical assistance. LPA provided the Community Care Licensing’s website WWW.CCLD.CA.GOV, so the Licensee can obtain updated licensing information, new regulations and access forms. LPA advised Licensee of their responsibility to stay current by reviewing PINs on the website.

No deficiencies cited based on today's inspection. LPA reviewed report with the Licensee. LPA observed the Notice of Site Visit posted and the Licensee understands it must remain posted for 30 days.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly Ferrara	TELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC809 (FAS) - (06/04)

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