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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409302
Report Date: 08/15/2022
Date Signed: 08/15/2022 10:48:03 AM

Document Has Been Signed on 08/15/2022 10:48 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SCHAEFER, MARNIFACILITY NUMBER:
073409302
ADMINISTRATOR:SCHAEFER, MARNIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 786-5671
CITY:DANVILLESTATE: CAZIP CODE:
94506
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
08/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marni SchaeferTIME COMPLETED:
11:00 AM
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On 8/15/22 at 9:00 am Licensing Program Analyst (LPA) Monica Mathur conducted an announced CHANGE OF LOCATION Inspection at Marni Schaefer's home and met with Applicant, Marni who has applied for a Large Family Child Care Home with a capacity of 14. Days and hours of operation will be Monday – Friday from 7:30 am - 5:30 pm. Present in the home were Applicant, her adult daughter, grandson, and 2 day care children (siblings from 1 family). Helpers will be adult daughter and an Assistant employee.

Applicant completed 8-hour Preventative Health & Safety training, Nutrition and Lead Poisoning training, 8-hour Pediatric CPR & First Aid, has documentation for Measles, Pertussis, Influenza opt out statement for the current flu season. Applicant and adults living in the home have Criminal Record and Child Abuse Index Clearance and documentation for Tuberculosis (TB) clearance. Applicant rents the home and submitted copy of rental agreement. LPA reminded that when care for more than 12 and up to 14 is provided, Applicant must notify parents and get landlord consent. Applicant has a working telephone in the home. Fire Clearance was granted on 7/12/22 which states Garage and Second Level can't be used for day care.

Two story home comprises of 4 bedrooms, 3 bathrooms, Kitchen, Living room, Family room, Dining room converted into Infant Room, Laundry room, attached Garage

Areas to be used for day care: Family room, Living room, Kitchen, Dining area converted into Infant Area, Hallway from Family room leading into Living room, Bathroom downstairs.
Off-Limit Areas: On Level 1: Laundry room, Bedroom downstairs, Garage.
Entire 2nd Level (consisting of 3 bedrooms, 2 bathrooms, 2 closets, landing area),
Isolation Area: Family room
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2022
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SCHAEFER, MARNI
FACILITY NUMBER: 073409302
VISIT DATE: 08/15/2022
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LPA toured the indoor space of the home. It is sanitary and orderly, with heating and ventilation for safety and comfort. Stairs in the home are barricaded. Fireplace is located in the Family Room and is screened/barricaded. LPA observed fully charged 2A10BC fire extinguisher, working smoke, carbon monoxide detectors. Medicines, cleaning products, sharp objects are stored inaccessible to children in cabinets. LPA reminded that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. Applicant states there are 3 pet dogs and no arms and ammunition stored in the home.

Outdoor Space: LPA toured the outdoor areas. Children will use the entire yard except the Right Side Yard which is inaccessible with a gate. The yard has fences on all sides. No bodies of water were observed.

LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with Applicant, and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SCHAEFER, MARNI
FACILITY NUMBER: 073409302
VISIT DATE: 08/15/2022
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Website links for provider resources:


Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.

Guardian website: www.guardian.dss.ca.gov

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Facility is recommended to be licensed as Large Family Home effective 8/15/22. Exit interview conducted and report was reviewed with the Applicant, Marni Schaefer.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC809 (FAS) - (06/04)
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