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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618185
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:20:46 PM


Document Has Been Signed on 09/22/2022 01:20 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:O' SHAUGHNESSY, MARY ANNEFACILITY NUMBER:
343618185
ADMINISTRATOR:O' SHAUGHNESSY, MARY ANNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 353-1094
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:14CENSUS: 12DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Mary Anne O'ShaughnessyTIME COMPLETED:
02:00 PM
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On Thursday, September 22nd, 2022, Licensing Program Analyst (LPA) Kelly Ferrara conducted an unannounced annual inspection and met with Licensee Mary Anne O'Shaughnessy. LPA observed there were currently 12 children in care with the Licensee and an assistant. Facility hours of operation are Monday through Friday 7:30 AM to 4:30 PM. LPA observed that the Licensing annual fees are current.

Licensee 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.

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 the cleaning compounds, medications, and sharp objects were kept inaccessible to children. LPA observed a 2A-10-BC fire extinguisher which is accessible. 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 LPA observed there were no bodies of water. Licensee stated there are no firearms in the home.

LPA observed a current children's roster, fire drill log and safe sleep log. LPA reviewed children’s files and observed that all the required documentation was present in each child's file. LPA observed the CPR/1st aide certificate was current and expires February 2024. LPA observed a current Mandated Reporter certificate for the Licensee and assistants. Licensee was reminded the Child Care portion must be completed every two years. LPA reviewed the assistant files and observed the required documentation was present in each staff file.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: O' SHAUGHNESSY, MARY ANNE
FACILITY NUMBER: 343618185
VISIT DATE: 09/22/2022
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://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.

Incidental Medical Services- IMS policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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. LPA discussed current COVID guidelines with Licensee and provided technical assistance.

LPA provided the Department’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.

There were no citations issued based on today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with the Licensee.
SUPERVISOR'S NAME: Natalie DunawayTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Kelly FerraraTELEPHONE: (916) 425-5932
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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