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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622689
Report Date: 08/12/2021
Date Signed: 08/20/2021 01:41:15 PM

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:RIAL, SHANICEFACILITY NUMBER:
393622689
ADMINISTRATOR:RIAL, SHANICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 609-2255
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:14CENSUS: 6DATE:
08/12/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Shanice RialTIME COMPLETED:
01:51 PM
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On 08/20/21 Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Shanice Rial for the purpose of annual inspection. LPA followed infection control protocols. Today's census was 5 preschool children and 1 infant. All residents and staff present had fingerprint clearances.

A tour of the home, inside and outside, as shown on the facility sketch was conducted. Off-limit rooms are all bedrooms and a shed in the side yard. Licensee acknowledges that children may never enter these off-limit areas. The backyard is fenced. Licensee stated there are no weapons and no bodies of water in the home. LPA observed poisons, cleaning compound's, medications and other hazardous items are inaccessible to children. Fire extinguisher, carbon monoxide detector and smoke detector meet regulations. Safe toys and play equipment are observed. LPA observed all the required postings, reviewed all 6 childrens records and staff records. Pediatric CPR/FA card valid till 5/23 and Mandated reporter AB 1207 certificate is valid till 08/2023. LPA reviewed children's roster and fire drill log with the last drill conducted on 5/10/21.

The facility is following all the Covid precautions while providing care for children. LPA discussed the Safe Sleep regulations.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the Licensee and provided copies. An exit interview was conducted. Appeal rights provided. Notice of Site Visit was provided, and licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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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