136610260-6-8-2023-20-CC-ECAA-CSLRJ6-20230608130325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 136610260
Report Date: 06/08/2023
Date Signed: 06/08/2023 01:03:40 PM

Document Has Been Signed on 06/08/2023 01:03 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	MAGANA, SHANNON FAMILY CHILD CARE		FACILITY NUMBER:	136610260
ADMINISTRATOR:	SHANNON MAGANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 960-0881
CITY:	HOLTVILLE	STATE: CA	ZIP CODE:	92250
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	06/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Shannon Magana		TIME COMPLETED:	01:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On June 8, 2023 at 11:30 a.m., Licensing Program Analyst (LPA), Edgar Campana conducted an unannounced Annual Required Inspection and met with the Licensee, Shannon Magana. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Eight (8) children and an assistant were present in the facility during this inspection. Assistant is cleared and associated. LPA toured the home. This is a one story, 5 bedroom and 3 bathroom home. The primary child care areas are the following: the living room, the kitchen, Bedroom #1 (only used to nap infants), Bedroom #2, Bedroom #3 (used to nap children), Bathroom #3, Bedroom #5, and the family room. The following areas have been made inaccessible through the use of locks or safety gates: bedroom #4, Bathroom #1, Bathroom #2, and the wash room. There is a sufficient amount of age appropriate toys, games and books available. The home has plenty of space for the children to eat, sleep and play, and was a comfortable temperature during this visit. Licensee is using her back yard for outdoor activities, it is properly fenced and 100% supervision was advised. There is a fireplace on the property and it is properly screened. The fire extinguisher, type 2-A:10-B:C, smoke detector, and carbon monoxide detectors met requirements. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expire on 08/30/2023. Licensee has required immunizations. Licensee's Mandated Reporter Training certification is not on file - deficiency cited. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted in February 2023, however there is no documentation - technical violation given.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MAGANA, SHANNON FAMILY CHILD CARE	FACILITY NUMBER: 136610260
	VISIT DATE: 06/08/2023

NARRATIVE

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LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

Incidental Medical services (IMS) policy was discussed. 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 informed licensee that one Type B citation is being cited on the attached LIC 809-D.

A copy of this report, appeal rights (LIC 9058), and LIC 9213 – Notice of Site Visit was provided to the licensee. Licensee was advised to post the LIC 9213 for 30 days. An exit interview was conducted with licensee, Shannon Magana.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/08/2023 01:03 PM - It Cannot Be Edited

Created By: Edgar Campana On 06/08/2023 at 12:56 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MAGANA, SHANNON FAMILY CHILD CARE	FACILITY NUMBER: 136610260
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA record review, the licensee did not comply with the section cited above in licensee did not have current Mandated Reporter Training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/15/2023
	Plan of Correction
1 2 3 4	Licensee was provided with link for CA Mandated Reporter Training: https://mandatedreporterca.com/training/child-care-providers Licensee stated that she will take training and will provide proof to Department by the POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Jason Garay

LICENSING EVALUATOR NAME:

Edgar Campana

LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC809 (FAS) - (06/04)

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