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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624180
Report Date: 02/07/2022
Date Signed: 02/07/2022 11:26:01 AM

Document Has Been Signed on 02/07/2022 11:26 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ROBINSON, SHAMEAFACILITY NUMBER:
343624180
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Shamea RobinsonTIME COMPLETED:
11:45 AM
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On Monday, February 7, 2022, at approximately 9:25 AM, Licensing Program Analysts (LPAs) Josiah Gathing and Christopher Bello met with Applicant Shamea Robinson for the purpose of an announced pre-licensing inspection. During today’s visit, the applicant and one adult resident were present. Additionally, two minor children were present in the home. Applicant plans to operate Sunday – Saturday from 6:00 AM to 9:00 PM.

A health and safety inspection was conducted inside and outside the home. The second story of the home has one bedroom, and bathroom, the first floor has three bedrooms, 2 bathrooms, laundry room, kitchen, two living rooms, game room, pantry, linen closet, backyard, pool area, and a detached garage. Off-limit areas will include the: Entire second floor, bedroom 2, bedroom 3, pool area, and garage of facility. Applicant understands that children may never enter the off-limit areas.



Sharp knives are stored in the kitchen, out of children’s reach. LPAs observed a charged 2A10BC fire extinguisher, functioning smoke detector, and functioning carbon detector. The fireplace is covered. A gate is in place to prevent children’s access to the second floor.

Applicant has completed the required Preventative Health and Safety course and the Lead Poisoning Prevention. Applicant's EMSA certified CPR and First Aid Certificate expires 11/01/2022. According to applicant, there are no weapons in the home.

The pool area is surrounded by a fence, with a self-latching gate. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed.

Report continues on LIC809-C...

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2022
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: ROBINSON, SHAMEA
FACILITY NUMBER: 343624180
VISIT DATE: 02/07/2022
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Applicant 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.

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 submitting 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 Applicant 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.

An exit interview was conducted with Applicant and Covid-19 protocols were discussed. LIC311D, records, postings, and reporting requirements were discussed. LPA discussed personal rights, criminal record clearances, ratios and capacity, and maintaining buildings and grounds. Applicant was encouraged to visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Copy of this report was reviewed and provided to licensee. This report will be kept in the facility file and will be made available for public review upon request.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Josiah Gathing
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
LIC809 (FAS) - (06/04)
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