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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100124
Report Date: 09/18/2023
Date Signed: 09/18/2023 02:56:26 PM


Document Has Been Signed on 09/18/2023 02:56 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:HAZLETT, SHAYNA FAMILY CHILD CAREFACILITY NUMBER:
376100124
ADMINISTRATOR:SHAYNA HAZLETTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 456-2680
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:14CENSUS: 2DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Shayna HazlettTIME COMPLETED:
03:15 PM
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On 9/18/23 at 1:30 PM Licensing Program Analyst (LPA) Annette Sutherland conducted an unannounced annual inspection with the Licensee. Upon arrival, LPA met with Licensee Shayna Hazlett, also present was licensee’s 2 minor children. Licensee was provided the Inspection Checklist (LIC 126). The 2-story home was toured and inspected to ensure an environment safe for the care and supervision of children. There were no day care children present. Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include living room, bedroom #1, bathroom #1 dining room, kitchen, playroom, and backyard. Off limits areas include entire upstairs, bedroom #1, bathroom #1, garage, and are inaccessible through use of safety gates and door latch. The licensee has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. LPA conducted childcare quality management interview with the Licensee. The staircase is barricaded.
The fire extinguisher (located in the kitchen area) meets regulation and is operational. The carbon monoxide detector/smoke detector (located in the hallway) meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There is a pool in the backyard that is properly fenced. Licensee states that there are no weapons in the home. First Aid and CPR certifications expire on May 2025 . Licensee has required immunizations. Licensee completed Mandated Reporter Training taken on 10/21/23 and is reminded it must be completed every 2 years. Children’s records were reviewed and found to be in order. Licensee maintains a current roster and is conducting emergency/disaster drills according to regulation.
Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2230
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HAZLETT, SHAYNA FAMILY CHILD CARE
FACILITY NUMBER: 376100124
VISIT DATE: 09/18/2023
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LPA directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. 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-andresources/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.
LPA reviewed with Licensee the LIC 311D, Forms/Records. To Keep in Your Family Childcare Homes, children’s forms/records, facility forms/records, and information to be posted. 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.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPA discussed and provided Licensee with the following: childcare advocates-email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Childcare Licensing Duty Line at (619) 767-2248.
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2230
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: HAZLETT, SHAYNA FAMILY CHILD CARE
FACILITY NUMBER: 376100124
VISIT DATE: 09/18/2023
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.


No deficiencies cited.


To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Exit interview conducted and report was reviewed with the licensee Shayna Hazlett .
During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2230
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
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