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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412635
Report Date: 11/03/2021
Date Signed: 11/03/2021 02:25:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MORALES, SHAELONFACILITY NUMBER:
434412635
ADMINISTRATOR:MORALES, SHAELONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 242-7671
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:14CENSUS: 5DATE:
11/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Shaelon Morales TIME COMPLETED:
02:35 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Aman Sharma and Samantha Yip conducted an unannounced annual inspection. Upon entering the home, they were greeted by Shaelon Morales who was caring for four children and one infant. The day care home is open Monday-Friday 7:30am-5:30pm. LPA's began the inspection by using the Care Tool.

During the Physical Plant section, Licensee stated master bedroom, 2nd bedroom, and 3rd bedroom are only used for the children to sleep and not play. She places them in the crib for their nap and picks them up and takes them to the on-limit area herself. An updated LIC 999A was obtained during today's inspection.

A fully charged fire extinguisher is kept in the home. Carbon Monoxide and Fire Alarms were in good condition and working. The home has proper heating, lighting, ventilation and is kept clean. No bodies of water were observed. LPAs reminded Licensee to dump any water that collects prior to children going outside.

Backyard is used and is fenced. LPAs observed that one of the panels were loose. Licensee stated that she will send proof that panel was fixed. There is a play structure that is anchored to the ground.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2153
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MORALES, SHAELON
FACILITY NUMBER: 434412635
VISIT DATE: 11/03/2021
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LPAs reviewed five children's files. A copy of current children's roster was obtained. LPAs discussed with Licensee Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Mandated Reporter Training (AB1207) for licensee is expired. Licensee has current Pediatric CPR/First Aid with an expiration date of September 7, 2023.

She conducted her emergency drill in July 2021. Licensee states she does not transport children at the moment, but understands children may never be left in parked vehicles. She understands car seat law.
Incidental Medical Services were discussed with the licensee. The licensee is not providing IMS (Incidental Medical Services) at this time. 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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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 http://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The adults 18 and over living in the home are Licensee and her fiance. All adults have cleared criminal record and child abuse index. Licensee stated that she will submit TB test for her finance to Licensing. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

COVID guidelines were discussed with Licensee.

As a result of this inspection, a Type B citation and technical violations were issued. An exit interview was conducted where this report, citation, plan of correction, and appeals rights were discussed and provided to Licensee Shaelon Morales. A Notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2153
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MORALES, SHAELON
FACILITY NUMBER: 434412635
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee last completed Mandated Reporter training in 2018, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2021
Plan of Correction
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By POC 12/20/2021, Licensee stated that she will complete Mandated Reporter training and send proof to LIcensing.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2153
LICENSING EVALUATOR NAME: Aman SharmaTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2021
LIC809 (FAS) - (06/04)
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