376100124-6-10-2020-51-CC-ERED-BQFN7D-20200610101233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376100124
Report Date: 06/10/2020
Date Signed: 06/10/2020 10:13:16 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	HAZLETT, SHAYNA FAMILY CHILD CARE		FACILITY NUMBER:	376100124
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	06/10/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Shayna Hazlett		TIME COMPLETED:	10:30 AM

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 06/10/2020 at 9:30 AM, Licensing Program Analyst (LPA) Elise Read conducted an announced virtual case management inspection for the purpose of a capacity increase with the licensee. Due to COVID-19, this inspection was completed via the Zoom app. Present in the home at the time of the inspection were licensee and 6 day care children. The 6 bedroom, 4 bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire clearance was granted on 06/04/20. The fire extinguisher (located in the kitchen), and carbon monoxide detector/smoke detector combination (located in the hallway) meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. The pool is made inaccessible to children by covering and fencing that meets regulation. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. First Aid and CPR certifications expire on 08/2021. Licensee meets immunizations requirements and Mandated Reporter Training AB 1207 was completed on 09/23/2019. Applicant will be using the following rooms for childcare: entire downstairs, besides bedroom #1. The following areas will be off limits: bedroom #1 and garage. Bedroom #1 is inaccessible through the use of a door latch and the garage is inaccessible through the use of a door knob cover. The applicant has sufficient toys and equipment available. The home has a backyard available for outdoor activities.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise Read	TELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HAZLETT, SHAYNA FAMILY CHILD CARE	FACILITY NUMBER: 376100124
	VISIT DATE: 06/10/2020

NARRATIVE

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The following information was reviewed with the applicant: information on reporting requirements for suspected child abuse and unusual incidents, children’s records, immunizations, adults living or working in the home and related civil penalties, shaken baby syndrome, Safe Sleep Regulation/SIDS, and Lead Exposure. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided licensee with the following: Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov and phone number (916) 654-1541. In addition, for common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

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.

No deficiencies are cited. No corrections are needed; a license for 14 will be issued effective today.

The licensee was provided a copy of their appeal rights via email, as well as this report ). Licensee will respond via email confirming receipt of the report and appeal rights, which will act as their signature for today's inspection. LPA provided notice of site visit via email. Licensee will submit photo of Notice of Site Visit posted in the home. Notice of Site Visit must remain posted for 30 days.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise Read	TELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

LIC809 (FAS) - (06/04)

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