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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629184
Report Date: 10/13/2021
Date Signed: 10/14/2021 07:04:07 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:BORDWELL, SHADY FAMILY CHILD CAREFACILITY NUMBER:
376629184
ADMINISTRATOR:SHADY BORDWELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 519-2549
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:14CENSUS: 0DATE:
10/13/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Shady BordwellTIME COMPLETED:
02:00 PM
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On 10/13/21 at 12:15 PM, Licensing Program Analysts (LPA) Adrian Castellon conducted an announced Pre-Licensing inspection. Upon arrival, LPA met with applicant Shady Bordwell. Applicant submitted an application for a large license as she has previous childcare experience.  This one story, two bedroom and one bath home was toured and inspected to ensure an environment safe for the care and supervision of children. A SDFD fire clearance report dated 10/12/21 has been received by the SDRO. The following areas will be used for daycare purposes: the entire home except for the kitchen which is properly barricaded via babygate. The fully fenced backyard will be used for outdoor play. Off limit areas include: front yard, but licensee will contact LPA Castellon when it is ready for use. Applicant plans to operate Monday thru Friday, 7:00 am to 5:00pm. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational.  Children’s toys and play equipment are safe and age appropriate. There are no bodies of water observed by LPA during inspection. There are no firearms or other weapons in the home, per applicant.  Pediatric CPR and First Aid certifications expire 08/2023. Preventative Health Practices/lead course was completed.  Primary telephone is a cell phone which is operational. 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.  Applicant's partner owns the home and has submitted proof. Applicant states that she is financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. Applicant has met immunization requirement per SB792 and has completed the AB1207 Mandated Reporter Training.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: BORDWELL, SHADY FAMILY CHILD CARE
FACILITY NUMBER: 376629184
VISIT DATE: 10/13/2021
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LPA discussed SAFE SLEEP PLAN and documentation was discussed. The provider physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age and shall be available to the Department for review. The provider should place infants up to 12 months of age on their backs for sleeping.

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 provided 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. LPA discussed California Megan's Law and provided Applicant with the following website: www.meganslaw.ca.gov. LPA informed applicant in order to access CCLD-Childcare regulations, quarterly updates, licensing forms, pay annual fee to visit the following website:  http://ccld.ca.gov. LPA discussed and provided applicant with the following: Child Care Advocates - (916) 654-1541 and email address childcareadvocatesprogram@dss.ca.gov. In addition, for common questions or questions regarding licensing requirements to contact Child Care Licensing duty line at 619-767-2248.


LPA informed applicant, license will be e-mailed. LPA informed applicant upon receipt of the license, the applicant shall post the license it in a prominent place. A Large license will be issued after a file review.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
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