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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700261
Report Date: 09/25/2024
Date Signed: 09/27/2024 10:24:05 AM

Document Has Been Signed on 09/27/2024 10:24 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LANDES, SHAYNAFACILITY NUMBER:
015700261
ADMINISTRATOR/
DIRECTOR:		LANDES, SHAYNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(347) 268-9561
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Shayna LandesTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On September 25, 2024 9:40am, Licensing Program Analyst (LPA) Randy Miranda arrived announced to meet with Licensee Shayna Landes for the purpose of conducting an annual inspection for health and safety. Present for the inspection was the licensee, licensee’s spouse, assistant, and 11 children in care (four 4-year old; one 3-year old; two 2-year old; one 23 mo. old; one 20 mo. old; two 18 mo. old). There was an uncleared adult present for a job interview. LPA requested the licensee to have the adult (future employee) vacate the facility due to not being fingerprint cleared. The hours of operation are Monday-Friday 8:00am to 5:00pm.

Fire clearance was granted by the Fremont Fire Department on July 24, 2023; the only restriction being the garage is considered off-limits to children in care. A pulldown fire alarm has been added and mounted on the wall near the southern sliding exit door from the family room. The home has a fully charged 2A10BC fire extinguisher mounted on the kitchen wall, combined smoke and carbon monoxide and a single carbon monoxide detector (tested and functioning), and a working telephone. Fire drills conducted at least once every six months, the last drill was documented May 8, 2023.



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 family room, and away from the other children in care.

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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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Document Has Been Signed on 09/27/2024 10:24 AM - It Cannot Be Edited


Created By: Randy Miranda On 09/25/2024 at 11:49 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: 09/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which the Licensee did not file an individual sleeping plan in each of the children's file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2024
Plan of Correction
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A copy of Individual Infant Sleeping Plan LIC9227 is to placed into each infant's file. Photo proof to be sent to LPA via email.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that the Licensee did not document 15 minute sleep sleep checks, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2024
Plan of Correction
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 Starting September 25, 2024, Licensee is to turn in weekly sleep logs for a total of 4 weeks, every Friday before end of day 5pm. Licensee to email LPA a pdf or photocopy. Licensee to provide a copy of sleep logs and file in the infant'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:Wynn Norona
LICENSING EVALUATOR NAME:Randy Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024


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Document Has Been Signed on 09/27/2024 10:24 AM - It Cannot Be Edited


Created By: Randy Miranda On 09/25/2024 at 12:52 PM
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: 09/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that the Licensee did not conduct and document current fire and disaster drills which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2024
Plan of Correction
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Licensee to conduct and document every six months, fire and disaster drills. Photo proof to be sent to LPA via email.

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:Wynn Norona
LICENSING EVALUATOR NAME:Randy Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024


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Document Has Been Signed on 09/27/2024 10:24 AM - It Cannot Be Edited


Created By: Randy Miranda On 09/25/2024 at 01:02 PM
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: 09/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101223(b)(1)(A)
(b) The center shall inform each child's authorized representative of the rights specified in (a) (1) through (8) above.

(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

(A) Each authorized representative shall be asked to sign and date the acknowledgement-of-receipt statement at the bottom of the LIC 613A (9/96). This documentation shall be kept in the child's file.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in which the children's file did not contain LIC613A which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/09/2024
Plan of Correction
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Signed and filed into each enrolled child's file. Photo proof if signed LIC613A to be sent to LPA, via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Wynn Norona
LICENSING EVALUATOR NAME:Randy Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024


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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LANDES, SHAYNA
FACILITY NUMBER: 015700261
VISIT DATE: 09/25/2024
NARRATIVE
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The licensee rents the home and carries liability insurance through State Farm, the policy is valid through June 25, 2025.

On-limit-areas include: Living room, family room, kitchen, bonus room (office) one bedroom for younger children learning and napping; the main house bathroom on the right side of the home entry door, main western and southern side of the back yard and the 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 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.

Children’s files were reviewed, a copy of the roster was taken for the office file. Children’s files were missing LIC613A. Two infant files were missing Infant Sleep Plan and 15-minute sleep logs. Licensee, spouse, and assistant are in compliance with all immunization laws 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 May 8, 2025. Mandated Reporter for licensee expires on 8/2/2025. Mandated Reporter for spouse expires on 8/1/2025. Mandated Reporter for assistant expires on 2/12/2026. The licensee, spouse and assistant are 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LANDES, SHAYNA
FACILITY NUMBER: 015700261
VISIT DATE: 09/25/2024
NARRATIVE
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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.

To improve the quality and value of the new inspection process, a survey may 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 were four deficiencies issued today. See attached Deficiency pages for additional information.

· Type B Violation: Children’s file missing LIC613A.


· Type B Violation: Disaster drills not conducted and logged.
· Type B Violation: Licensee did not maintain sleep logs and Infant Sleep Plan.

· Type B Violation: Recent Fire and Disaster Drills not logged.

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

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

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Randy Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
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