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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622790
Report Date: 01/28/2022
Date Signed: 01/28/2022 02:51:14 PM

Document Has Been Signed on 01/28/2022 02:51 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:LEVIN, SHELLEY & IANFACILITY NUMBER:
343622790
ADMINISTRATOR:LEVIN, SHELLEY & IANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 773-2853
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
01/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Shelley and Ian LevinTIME COMPLETED:
12:30 PM
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On Friday, January 28, 2022, at 11:10 AM, Licensing Program Analyst (LPA) Tanya Washington conducted an unannounced Required 1 year annual inspection and met with Licensees, Shelley and Ian Levin. LPA observed care and supervision of three preschool age children. The off-limit areas include: both bedrooms and shed in the backyard. Licensee acknowledged that children may never enter these off-limits area. Licensees mainly operate their program outdoors and children have limited access to the home.
Licensee stated there are no new residents in the home since licensure. The hours of operation are Monday through Thursday from 8:00 AM to 3:30 PM and Friday's are from 8 AM to 12:30 PM.

LPA observed current CPR/First Aid certificates for both Licensees which expire on 11/21/2022. LPA reviewed three children’s files. LPA observed that there were no hazardous items accessible to children. There is no fire place in the home. LPA observed that cleaning materials were inaccessible. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Toys appear to be safe. Currently there are no bodies of water on the premises, the Licensee has removed the seasonal pool due to weather and plans to set up the above ground pool when weather permits. Licensees were reminded to contact the licensing office to ensure pool fencing is in compliance. There are no weapons in the home. LPA discussed current COVID guidelines with Licensee.

LPA observed a current fire drill log and children’s roster. Proof of AB1207 mandated reporter training was observed for both Licensees expiring 05/28/2023. LPA explained that the OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. Licensees are aware that the training must renewed every two years.

Licensees were 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.

REPORT CONTINUED ON NEXT PAGE

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2022
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: LEVIN, SHELLEY & IAN
FACILITY NUMBER: 343622790
VISIT DATE: 01/28/2022
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This facility does not currently provide Incidental Medical Services- IMS. 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 provided Licensee the Safe Sleep PIN 20-24 CCP and Infant Individual Sleeping Plan (LIC 9227).

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.

LPA reminded Licensees to pay their annual fee which was due on 01/24/2022. Licensee stated she did not receive a statement in the mail and will pay it this afternoon.



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/process.

In the areas that were evaluated, no Tittle 22 deficiencies were observed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Shelley Levin.

SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
LIC809 (FAS) - (06/04)
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