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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405377
Report Date: 03/23/2023
Date Signed: 03/23/2023 11:34:38 AM

Document Has Been Signed on 03/23/2023 11:34 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GOODRICH, SHELLY AFACILITY NUMBER:
073405377
ADMINISTRATOR:GOODRICH, SHELLY AFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 672-4027
CITY:CLAYTONSTATE: CAZIP CODE:
94517
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shelly GoodrichTIME COMPLETED:
11:40 AM
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On March 23, 2023, Licensing Program Analysts (LPAs) Melissa Domantay and Melissa Guirit conducted an unannounced Annual Inspection with Licensee Shelly Goodrich. Residing in the home is the licensee and her fingerprint cleared husband. Present upon arrival was fingerprint cleared assistant and 7 preschool children and 3 infants. Operating hours are 7:00AM to 5:30PM, Monday through Friday. The facility operates as a large Family Day Care Home.

The home is a two story house that consists of 5 bedrooms and 2.5 bathrooms. The OFF LIMIT AREAS are the entire upstairs, laundry room, and the garage, which will be inaccessible by closed and/or locked doors, gates, or visual supervision. The ON LIMIT AREAS are the living room, family room, kitchen area, downstairs bathroom, and backyard. The ISOLATION AREA will be in the front living room. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. The outdoor play area is a fenced in backyard. LPAs observed the following precautions, there is a fire place in the family room that is covered, cabinets and drawers have safety latches and the off limit areas have gates to prevent access. Per Licensee, there are no firearms in the home.

The home has a fully charged 3A40BC fire extinguisher and a live ADT smoke detector, fire alarm system, and carbon monoxide detector on the ceiling in the hall. The telephone is in working condition, and the First Aid Kit is complete. The Licensee's CPR and First Aid certificate is current and expires on 08/2024. The home's last fire drill was conducted on 3/16/2023. Licensee has confirmed no children in care require medication. Required posters are posted on the parent board. Report continues on 809 c.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: GOODRICH, SHELLY A
FACILITY NUMBER: 073405377
VISIT DATE: 03/23/2023
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The Licensee was reminded of the responsibility as a mandated reporter and has provided proof of the required training for child care providers.

Licensee 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. All forms can be downloaded at www.ccld.ca.gov .

There are no deficiencies cited today. An exit interview was conducted with Licensee and copy of report, notice of site, and appeal rights provided to Shelly Goodrich.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC809 (FAS) - (06/04)
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