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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616676
Report Date: 04/25/2022
Date Signed: 04/25/2022 10:42:34 PM

Document Has Been Signed on 04/25/2022 10:42 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:KELLY, SHARONFACILITY NUMBER:
393616676
ADMINISTRATOR:KELLY, SHARONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 943-5904
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
04/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Sharon KellyTIME COMPLETED:
03:45 PM
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On Monday, April 25, 2022, at 02:05 pm, Licensing program Analyst (LPA) Elvira Sierra met with Licensee, Sharon Kelly for the purpose of an unannounced annual inspection. Upon arrival present in the facility was Licensee and no children were present. At 02:40 pm, Licensee left the home to pick up three school age children and LPA waited outside the home. Licensee arrived at 03:25 pm and LPA continued with the inspection. Facility hours of operation are seven days a week 24 hours a day. Licensee was reminded never to exceed 24 hours of consecutive care. All individuals subject to criminal background review have obtained a criminal record clearance.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include; Entire upstairs, living room, laundry room, garage and the left side of the backyard. Upon entry, LPA observed the required postings. Facility maintains a working phone, smoke/carbon monoxide detector and a 2A10BC fire extinguisher. Home is appropriately ventilated and age appropriate toys and reading material were observed. Toxic and hazardous items we observed inaccessible to children. Licensee stated there are no weapons in the home and no bodies of water were observed on the premises. Outdoor play area is free from defects or dangerous conditions and fenced for supervision. Licensee stated trampoline is of limits to the daycare children.
Licensee provides meals to the children. First Aid Kit is fully stocked and accessible. Fire drills are conducted at least once every six months and are properly logged.
Two children’s files were reviewed and are complete. Licensee's EMSA CPR and First Aid certification was verified and expires on 03/07/24 and AB 1207 Mandated Reporter Training expires on 04/14/24.

LPA verified the annual fees are current. Licensee 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. -----------------Report continues on subsequent page 809C
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2022
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: KELLY, SHARON
FACILITY NUMBER: 393616676
VISIT DATE: 04/25/2022
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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 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 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 [facility representative] 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.

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.
A Notice of Site Visit was given and must remain posted to the interior side of the main door for 30 days. LPA posted the Notice of Site Visit on today's inspection.

Exit interview conducted and report was reviewed with the Licensee.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022
LIC809 (FAS) - (06/04)
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