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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216256
Report Date: 03/02/2022
Date Signed: 03/02/2022 02:04:29 PM


Document Has Been Signed on 03/02/2022 02:04 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:NEALLY-SPORTATO FAMILY CHILD CAREFACILITY NUMBER:
566216256
ADMINISTRATOR:SHAUNA NEALLY-SPORTATOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 453-0832
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY:14CENSUS: DATE:
03/02/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:SHAUNA NEALLY-SPORTATOTIME COMPLETED:
02:17 PM
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On 3/2/2022, at 11:52am Licensing Program Analyst (LPA) Michael Mathew conducted an announced Prelicensing inspection. Prior to entering the facility, LPA met with applicant Shauna Neally-Sportato and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Adults in the home have obtained a criminal background clearance. Applicant and LPA toured the facility inside and outside.

The home is a 3 bed, 2 bath, single story home. The applicant will use play room/bedroom, one bathroom, kitchen, living room, and backyard for care. LPA observed that home is to be clean and orderly. No bodies of water were observed on site. There are age appropriate toys and furnishings in good condition and free of hazards in the playroom. Applicant stated that bedroom #1, bedroom #2, side yard, and garage are off limit. LPA observed baby proof knobs and locks on all off limit rooms, and are inaccessible to children. LPA observed a fireplace in the living room with a glass screen which applicant added a lock and made it inaccessible to children. LPA observed knifes, cleaning compounds stored in the kitchen cabinet high away from children. Applicant stated that there are guns and ammunition stored separately in a large locked box in the garage, which is locked and is inaccessible to children. The backyard/patio is fully enclosed with a fenced wall. LPA observed a above ground fire pit with a wooden covered.. LPA observed three storage sheds and 2 storage bins that are locked and inaccessible to children. LPA observed side yard to be gated, locked and inaccessible to children. Applicant's Pediatric First Aid/CPR certificate is current and is valid until 2/6/2024. Applicant's mandated reporter training certificate is current and valid until 2/21/24.

LPA observed a 2A10BC fire extinguisher purchased on 1/16/22. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA had applicant test smoke alarm and carbon monoxide detectors in the home and were found functional.

Continued on 809-C

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: NEALLY-SPORTATO FAMILY CHILD CARE
FACILITY NUMBER: 566216256
VISIT DATE: 03/02/2022
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 LPA reviewed and verified control of property by review of Grant Deed naming the applicant with a reference to the address. Preventative Health and Safety and Nutrition Training was completed on 6/10/2021.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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 reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

Entrance Checklist was provided to the applicant.

LPA provided COVID-19 self assessment guide.

Exit interview conducted and report was reviewed with the applicant,

License to operate a Family Child Care facility is effective today 3/2/2022.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Michael MathewTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC809 (FAS) - (06/04)
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