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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700261
Report Date: 08/17/2021
Date Signed: 08/17/2021 09:57:45 AM

Document Has Been Signed on 08/17/2021 09:57 AM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LANDES, SHAYNAFACILITY NUMBER:
015700261
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/17/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Shayna LandesTIME COMPLETED:
10:00 AM
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August 17, 2021 at approximately 8:00 am Licensing Program Analyst (LPA) Russ Haderer met with applicant Shayna Landes for the purpose of conducting an announced pre-licensing inspection. Living in the home is the applicant, her fingerprint cleared and TB tested husband. Present for today’s inspection was the applicant. The hours of operation will be Monday-Friday, 8:00AM to 6:00PM, Fridays close at 3:00pm.

The facility is a single story 5 bedroom, 3 bath home with an attached 2-car garage. It is rented by the applicant and contains a living room, family room with a fireplace, kitchen, office, five bedrooms (1 master), attached 2-car garage an enclosed (fenced) side and backyard area. The home is neat and clean with heating and ventilation for safety and comfort. Per the applicant, the ISOLATION AREA will be in the office area that’s attached to the living room, and away from the other children in care.

On-limit-areas include: Living room, family room, kitchen, one bedroom for napping and main house bathroom on the right side of the home entry door, and main back yard area with a deck. Applicant was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Off-limit-areas include: The office (off the living room), remaining 4 bedrooms of the home, hallway leading the four remaining bedrooms, the house bathroom in the hall between two bedrooms, the master bathroom, attached 2-car garage, front yard and northern side of back yard. The off-limit areas will be inaccessible by closed and/or locked doors, child gates and/or by child supervision.



There is a fireplace in the family room (day care area) with a glass door to prevent child access. Children have cubbies for personal item storage. Per applicant, there are no firearms in the home. A copy of the rental agreement was reviewed and a property owner notification form (LIC9151) has been issued. Ratios were discussed and a copy left for applicant as a reminder
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LANDES, SHAYNA
FACILITY NUMBER: 015700261
VISIT DATE: 08/17/2021
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Applicant has ample age-appropriate toys and learning materials. The home has a fully charged 2A10BC fire extinguisher, working smoke and carbon monoxide detectors (tested and functioning), and a working telephone. The applicant’s Health and Safety training is completed, and CPR and First Aid certificate is current and expires July 11, 2023. Mandated Reporter has been completed and expires 7/12/2023. The applicant is in compliance with the immunization laws which pertains to day care providers.

LPA reminded applicant of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA discussed Unusual Incidents Reports.


LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection.


Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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 provided a copy of Safe Sleep-in Child-Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes. For licensing updates email childcareadvocatesprogram@dss.ca.gov and advised to be added to the email list
This home is recommended for Licensure as of today, August 17, 2021. Exit interview was conducted, this report shall remain on file for 3 years.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
LIC809 (FAS) - (06/04)
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