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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500407
Report Date: 10/27/2022
Date Signed: 10/27/2022 02:04:26 PM

Document Has Been Signed on 10/27/2022 02:04 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:SHINE, TIFFANYFACILITY NUMBER:
394500407
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
10/27/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Tiffany ShineTIME COMPLETED:
02:30 PM
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On October 27th, 2022, at 12:20PM, Licensing Program Analyst (LPA) Elvira Sierra conducted a Case Management visit for the purpose of increasing the licensed capacity from 8 to 14 children. LPA met with Licensee, Tiffany Shine. Fire Safety Inspection Clearance was granted on 10/19/22 for a total capacity of 14 children. Facility hours of operation are M-F 07:30AM to 05:30PM. All individuals subject to criminal background review have obtained a criminal record clearance. LPA observed Licensee caring for six children. One of the children was Licensees own child.

A health and safety inspection was conducted in all areas accessible to children. Home appears orderly and suitable for children. Off-limits areas include; bedroom #2 and #3 (including master bathroom), laundry room, and garage. Hazardous items were stored inaccessible to children. Napping equipment and age appropriate toys were observed. Licensee stated there are no weapons in the home. No bodies of water were observed. Home as a working telephone, 2A10BC fire extinguisher and a functioning smoke and carbon monoxide detectors. The backyard is fenced for supervision. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. Licensee rents the home. Lease agreement and LIC 9149 (Property Owner/ Landlord Consent) is filed. Licensee current CPR/First Aid was verified (04/23). Mandated Reporter Training expires on 04/15/23. During the inspection LPA reviewed large family childcare home capacity limitations with licensee and a capacity roster was provided to Licensee.


Capacity increase is approved as of Today, 10/27/22. The facility is licensed to serve a MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

Notice of Site Visit was provided and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the Licensee, Tiffany Shine. .
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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