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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402528
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:35:00 PM

Document Has Been Signed on 09/21/2022 03:35 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SHAVER, KARENFACILITY NUMBER:
073402528
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
09/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Karen Shaver TIME COMPLETED:
03:35 PM
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On 9/21/22 at 1:30 PM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Annual inspection Karen Shaver Family Childcare Home. LPA met with Karen and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the Home. The family childcare home days and hours are Monday to Friday 7:00 AM to 5:00 PM. Present in the home at time of inspection were licensee, licensee's husband, 1 infant and 3 preschool.

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.

Indoor Space: A health and safety tour of inside the home was done. LPA toured the premises with licensee. The home is sanitized and orderly in compliance with Title 22 Regulations at this time. There is a 3A40BC fire extinguisher, working smoke and carbon monoxide detector in the home.



The OFF-LIMIT areas are the master bedroom, master bathroom and bedroom. These areas are inaccessible to children in care by safety gates and child proof door knobs. IN-USE dinning room, living room, kitchen, playroom, bedroom and backyard. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets and draws with magnetic locks. LPA reminded licensee that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Licensee states that there are 2 dogs. There are no arms and ammunition stored in the home.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SHAVER, KAREN
FACILITY NUMBER: 073402528
VISIT DATE: 09/21/2022
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Outdoor Space: LPA toured the outdoor area (backyard) and observed it was fully fenced. LPA observed there are no pools, hot tubs or other bodies of water. LPA observed sheds that were locked.

Children files and Facility files were reviewed. Facility contained Children's Roster, Licensee’s mandated reporter training expires 6/24, Pediatric CPR and First aid expires 4/24.

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

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

There were no deficiencies cited during today's inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Karen Shaver.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC809 (FAS) - (06/04)
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