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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503907958
Report Date: 12/20/2021
Date Signed: 12/20/2021 12:30:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MILLER, SHANNON & PEEL, CAROLYN FAMILY CHILD CAREFACILITY NUMBER:
503907958
ADMINISTRATOR:MILLER, SHANNON & PEEL, CAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 526-2002
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:14CENSUS: 7DATE:
12/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Shannon MillerTIME COMPLETED:
01:00 PM
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On 12/20/2021 Licensing Program Analysts (LPA), Rene Mancinas and Diane Mercado, conducted an unannounced Annual Required Inspection and was met by Licensees, Shannon Miller and Carolyn Peel. Days and hours of operation are Monday through Friday 06:30am to 05:30 pm, or as arranged.

LPA reviewed current facility sketch and LPA toured the home inside. This is a two-story home. Licensee confirmed that the living room (day care room), downstairs bathroom, kitchen, two dining rooms, and the backyard are accessible for children to use. Stairs are barricaded at the bottom to prevent children from accessing stairs and second-story of the home. There are pets at this home. Licensees understands responsibility of any action taken by pets involving daycare children. There is no in-ground pool or other bodies of water. There are no firearms or ammunition at this home. No poisons were observed during the inspection.

There is a fireplace that is screened off and made inoperable. There is a working fire extinguisher, smoke detector, carbon monoxide detector, and adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The home has working telephone service and LPA confirmed the phone number.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area located on the side of the house is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

(Continued on 809-C)

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MILLER, SHANNON & PEEL, CAROLYN FAMILY CHILD CARE
FACILITY NUMBER: 503907958
VISIT DATE: 12/20/2021
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LPA discussed Safe Sleep Regulations with licensee. Licensee understands she is to physically check on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is to be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are to be placed on their backs for sleeping.

Licensee’s Pediatric CPR/First-Aid is current and set to expire on 04/24/2023. Child Abuse Mandated Reporter Training was completed on in 03/25/2018. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. 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



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, 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.

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 applicants 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 and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are being cited/issued. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days. Exit interview conducted with Licensees.

SUPERVISOR'S NAME: Susie FanningTELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Rene MancinasTELEPHONE: (559) 341-4524
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
LIC809 (FAS) - (06/04)
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