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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503907958
Report Date: 11/29/2022
Date Signed: 11/29/2022 01:42:02 PM


Document Has Been Signed on 11/29/2022 01:42 PM - It Cannot Be Edited

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: 5DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Shannon Miller TIME COMPLETED:
01:45 PM
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On 11/29/22, Licensing Program Analyst (LPA) Priscilla Zamudio, 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, 7:00 am-5:00 pm.

LPA toured the home inside and outside and a census was taken of 5 children. 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.

The fireplace located in the living room is made inaccessible by a glass/screen door and will not be in use during daycare hours. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. The home has working telephone service and LPA confirmed the phone number is (209) 526-2002.

There was one infant in care. LPA discussed Safe Sleep Regulations with licensee. There was a play yard for the infant in care. Play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the play yard. Infants are not swaddled while in care. Provider physically checks 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. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.


SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla ZamudioTELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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: 11/29/2022
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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 in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months. Both Licensee’s Mandated Reporter Training were completed on 1/4/22. Both Licensee’s pediatric CPR/First Aid expire on 4/24/23. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.
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 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.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

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 cited.
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.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Priscilla ZamudioTELEPHONE: (559) 578-7350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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