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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624180
Report Date: 01/22/2024
Date Signed: 01/22/2024 04:27:21 PM

Document Has Been Signed on 01/22/2024 04:27 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ROBINSON, SHAMEAFACILITY NUMBER:
343624180
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
01/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Shamea RobinsonTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kyrsten Williams conducted an unannounced annual inspection and met with the facility’s assistant, And-rea Robinson. LPA observed one child in care being supervised with the assistant. At approximately 3:35, Licensee returned to the home with two additional children. Facility hours of operation are 24 hours and 7 days a week. LPA observed that the annual facility fees are current.

LPA conducted a health and safety inspection and observed that the facility is in good repair with ventilation. LPA observed the required documents were posted where visible to parents. LPA observed that there were no hazardous items—such as cleaning compounds, medications, or sharp objects—accessible to children. The fire extinguisher appeared to be in working condition and accessible. LPA observed the smoke and carbon monoxide detectors are functioning. The facility has equipment and toys safe for children. The backyard is fenced, and the licensee acknowledged that in areas that are not fenced, 100% supervision is required. The licensee stated there are no weapons on the premises. LPA observed the facility has a pool on the premises. LPA observed the pool is properly fenced. Licensee and assistant acknowledges 100% supervision is required around bodies of water. Off limit areas include: entire second floor, bedroom 2, bedroom 3, pool area, and garage. Licensee and assistant understands that child care children must not enter the off limits areas of the home.

LPA observed a current children's roster. LPA did not observe documentation of completed fire drills. LPA reviewed children’s files and observed that all the required documentation was present in each child's file. LPA observed the CPR/First Aid certificate was current and expires February 2025. LPA observed a current Mandated Reporter certificate for the licensee, however did not observe one for the assistant. The licensee was reminded the Child Care portion must be completed every two years. LPA reviewed staff and facility files and observed the required documentation.

The licensee was informed of the www.MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
PAGE 1. REPORT CONTINUES ON LIC809-C
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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Document Has Been Signed on 01/22/2024 04:27 PM - It Cannot Be Edited


Created By: Kyrsten Williams On 01/22/2024 at 03:34 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ROBINSON, SHAMEA
FACILITY NUMBER: 343624180

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2024

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
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Based on interview and record review, the licensee did not comply with the section cited above in the assistant did not have current Mandated Reporter Training Certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/22/2024
Plan of Correction
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Assistant complete required Mandated Reporter Training. Licensee will submit certificate to LPA via email or text message to verify completed training.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 01/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2024


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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ROBINSON, SHAMEA
FACILITY NUMBER: 343624180
VISIT DATE: 01/22/2024
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The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA discussed the safe sleep regulations with the 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Deficiencies are cited on the subsequent page of this report (LIC809-D) under the California Code of Regulations, Title 22. The licensee was provided a copy of their Appeal Rights (LIC9058) and the licensee's signature on this form acknowledges receipt of these rights.

Exit interview conducted and report was reviewed with the licensee, Shamea and And-rea Robinson. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC809 (FAS) - (06/04)
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