015700261-7-1-2022-52-CC-RHAR-CFWPMQ-20220701112642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700261
Report Date: 07/01/2022
Date Signed: 07/01/2022 11:26:53 AM

Document Has Been Signed on 07/01/2022 11:26 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, SHAYNA		FACILITY NUMBER:	015700261
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 8	DATE:	07/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Shayna Landes		TIME COMPLETED:	11:31 AM

NARRATIVE

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On July 1, 2022 at approximately 8:40am, Licensing Program Analyst (LPA) Russ Haderer arrived unannounced and met with licensee Shayna Landes for the purpose of conducting an annual inspection. The child care has closed this week (until July 5, 2022) for summer break; therefore there were no children in care today. There are 6 children enrolled (2 two-years old; 1 three-years old; 1 four-years old; 2 five-years old). Present for the inspection was the licensee, her fingerprint cleared and TB tested husband. The hours of operation will be Monday-Friday, 8:00 AM to 6:00PM.

The facility is a rented single story 5-bedroom, 3 bath home with a living room, family room with a fireplace, kitchen, bonus room (office), an enclosed (fenced) side and backyard area and an attached 2-car garage. The home is neat and clean with heating and ventilation for safety and comfort. Per the licensee, 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, bonus room (office) 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. Licensee 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 remaining 4 bedrooms of the home, hallway leading to 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.

The licensee rents the home and carries liability insurance through State Farm, the policy is valid through June 25, 2023.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LANDES, SHAYNA	FACILITY NUMBER: 015700261
	VISIT DATE: 07/01/2022

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There are ample age-appropriate toys and learning materials and children have cubbies for personal items. There is a fireplace in the family room (day care area) with a glass door to prevent child access. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection. Per licensee, there are no firearms in the home.

The home has a fully charged 2A10BC fire extinguisher in the kitchen, a working smoke and carbon monoxide detectors (tested and functioning), and a working telephone. Fire drills are conducted at least once every six months, the last drill was done January 28, 2022.

Children’s files were reviewed, one child’s file was missing the LIC995A parent’s rights form see LIC809D, all other records were complete and in good order. Licensee and helper are in compliance with all immunizations and requirements of Title 22 regulations.

The licensee’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 licensee is in compliance with the immunization laws which pertains to day care providers. LPA reminded licensee 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.

Incidental Medical Services (IMS) policy was discussed. 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

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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

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: 07/01/2022

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There was one deficiency issued today, see LIC809D. This report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Shayna Landes.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/01/2022 11:26 AM - It Cannot Be Edited

Created By: Russell Haderer On 07/01/2022 at 11:07 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LANDES, SHAYNA	FACILITY NUMBER: 015700261
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)(1)

Admission Procedures and Authorized Representatives Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that the signed and dated receipt of the LIC995A form was missing from one child's file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/08/2022
	Plan of Correction
1 2 3 4	Licensee to have parent sign and date the form and keep it in the child's file.

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:

Chandra Charles

LICENSING EVALUATOR NAME:

Russell Haderer

LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

LIC809 (FAS) - (06/04)

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