Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618501
Report Date: 05/31/2019
Date Signed: 05/31/2019 02:13:20 PM

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:RODRIGUEZ, SHAWNAFACILITY NUMBER:
343618501
ADMINISTRATOR:RODRIGUEZ, SHAWNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 349-9791
CITY:SACRAMENTOSTATE: CAZIP CODE:
95842
CAPACITY:14CENSUS: 8DATE:
05/31/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Shawna RodriguezTIME COMPLETED:
02:30 PM
NARRATIVE
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LPAs Pitts and Washington met with licensee Shawna Rodriguez for the purpose of an annual random inspection. The facilities’ hours of operation are 5:30AM to 5:30PM Monday-Friday. The facilities annual fees are current. Upon arrival, Licensee, 8 pre-school children, and Assistant #1 was also present during the inspection. All individuals subject to criminal background review have obtained a criminal record clearance. A health and safety evaluation was conducted in all areas accessible to children. Off-limits areas include the garage, back bathroom and office. LPAs observed a working phone, 3A40BC fire extinguisher, first aid kit and functioning smoke and carbon monoxide detectors. Per licensee, there are no weapons in the home. No children were observed in parked cars. There are no accessible bodies of water on the premises. Toxic and hazardous items are inaccessible to children. Safe toys and comfortable accommodations were observed. The fireplace in the home is appropriately barricaded to prevent access by children.

Licensee does not provide Incidental Medical Services (IMS) at this time. For IMS information, licensee was advised to see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.


Report continued on 809-C
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Rosie PittsTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
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: RODRIGUEZ, SHAWNA
FACILITY NUMBER: 343618501
VISIT DATE: 05/31/2019
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A sample of staff and children's records were reviewed. Required postings, a current roster, disaster drill log and proof of immunization's were observed. Current EMSA Certified pediatric CPR and first aid certification was verified and expires: 5/2021. Current AB 1207 Mandated Reporter Training was verified for both the licensee (exp 1/2020) and assistant #1 (exp 3/2020). The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/

LPAs discussed new safe sleep and lead exposure regulations. LPAs provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so Licensees can request to be added to the distribution list to receive Quarterly Updates. LPAs provided and discussed the Safe Sleep in Child Care and Effects of Lead Exposure brochures.

This facility evaluation report was reviewed and discussed with the licensee. A notice of site visit was provided and should remain posted for 30 days for parental review. Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of 3 years for public review upon request.



In the areas that were evaluated, no Title 22 deficiencies were cited.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Rosie PittsTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
LIC809 (FAS) - (06/04)
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