384002083-6-7-2019-05-CC-BVAN-BCWNA4-20190607101657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384002083
Report Date: 06/07/2019
Date Signed: 06/07/2019 10:17:07 AM

COMPREHENSIVE INSPECTION

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SAMERS, SHEYNDEL		FACILITY NUMBER:	384002083
ADMINISTRATOR:	SAMERS, SHEYNDEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 664-3068
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY:	14	CENSUS: 9	DATE:	06/07/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Samers, Sheyndel		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	Licensing Program Analyst (LPA) Van met with Licensee, Sheyndel Samers and licensee helper's (Yakushenko, Polina) for an unannounced annual random inspection. The purpose of the inspection was explained. Present today is 9 children (3 infants and 6 preschools) in care with licensee. Licensee is operating within capacity requirements on this day. Days and hours of operation are Monday- Friday 7:00AM - 5:30PM. Licensee states that sick children will be separated from the group and will be waiting in the bedroom for parents to pick up. Day Care Areas: Living room, dining room, bathroom, kitchen and front yard. Off-limits Areas: master bedroom, and back yard. LPA and Licensee inspected the day care areas. The home has properly lighting and ventilation. There are no pools, spas or other bodies of water on the property. Per licensee there are no firearms, weapons, or pets in the home. Fireplace is barricaded and inaccessible to children in care. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. The home is equipped with a fully charged fire extinguisher, smoke alarm, carbon monoxide detectors and a working telephone. There is an adequate supply of toys and other learning equipment for the children. Furniture, and high chairs are in good condition. LPA did not observe any walkers, bouncers or any similar items. Licensee understands that smoking is prohibited in family child care homes. LPA observed licensee has posted all the required forms (i.e. License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). Licensee has a complete and up to date current roster of children in care. Fire drills are conducted and documented accordingly, last fire was completed on 2/4/129. The licensee has complete records for children in care, including immunization records and Parents' Rights forms. Licensee CPR/First Aid will expire on 1/2020. Discipline policy was discussed. Licensee states her discipline method will be talking to the child, and she will use the "magic chair" when necessary to help the child to cool down. LPA reminds licensee that for time-out, there is one minute per child’s age, and no more than 5 minutes. Continue on the next page..................................

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SAMERS, SHEYNDEL	FACILITY NUMBER: 384002083
	VISIT DATE: 06/07/2019

NARRATIVE

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LPA reviewed supervision, capacity requirements and expectations with licensee. Licensee states that she does not transport children but understands never to leave children unattended in vehicles. Licensee states she understands her capacity options. LPA reviewed safe sleep for infants and provided informational handout.

Licensee is aware that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles.

LPA reviews AB 1207 with the licensee. As of January 1, 2018, all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Licensee states that no one has mention this to her, she states that she will complete the online training and will email the completion to LPA when finished.

Advisory: Avoid stacking items and toys on top of the bookshelves to prevent injuries to children.

No deficiencies were observed today. A copy of this report was reviewed and provided to the licensee. This report will be kept in the facility file and will be made available for public review upon request. Notice of Site Visit was observed to be posted and shall remain posted for 30 days.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon Van	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019

LIC809 (FAS) - (06/04)

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