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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409405
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:45:35 AM

Document Has Been Signed on 05/04/2023 11:45 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:SHIRDEL, SARAFACILITY NUMBER:
073409405
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/04/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:SARA SHIRDELTIME COMPLETED:
11:45 AM
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Licensing Program Analyst Alexander met today with for an ANNOUNCED RE-LOCATION INSPECTION. Present for the inspection is applicant and two infants, one of which is the applicant's own child. The home is a one story house consisting of 3 bedrooms, 2 bathrooms, living room, kitchen, dinning room and detached The garage. The primary areas for day care will be the dinning room, 1st bedroom,, hall bathroom, and backyard. The off-limits areas will be the living room, master bathroom, the area on the right side of the backyard which houses the barbeque, and the detached garage. These areas will be inaccessible to children in care by closed and/or locked doors and visual supervision. Applicant and her husband own the home; proof was shown. Per applicant there are no firearms/weapons located on the premises. There is a fully charged 2A10BC fire extinguisher in the home and a working smoke alarm/ carbon monoxide detector combo which was tested today and is in working condition; recommended periodic servicing. There are no swimming pools, hot tubs or other bodies of water located on the premises. All sharp knives, cleaning solutions and medications are inaccessible to children in care. First aid kit is available and complete. The isolation area for sick children will be in the master bedroom. Outdoor play will be in the fully fenced backyard. There are toys and play space available. Applicant was instructed to conduct and document periodic fire and disaster drills. Applicant was informed that baby walkers, exersaucers and baby bouncers are not allowed. Applicant has completed CPR and first aid training which expires in 4/2025 respectively. Applicant has completed her 16 hours of health and safety training which included the 1 hour of Nutrition and 1 hour of Lead poisoning training.

DURING TODAY'S RE-LOCATION INSPECTION THE NEWLY IMPLEMENTED INFANT SAFE SLEEP REGULATIONS WERE DISCUSSED AND MATERIALS WERE GIVEN. TODAY THERE IS A CRIB AND PLAY PEN FOR INDIVIDUAL NAPPING.

All forms can be downloaded at www.ccld.ca.gov. www.myccl.gov for day-care updates.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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: SHIRDEL, SARA
FACILITY NUMBER: 073409405
VISIT DATE: 05/04/2023
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Mandated reporter and appeal rights were discussed. Licensing forms were reviewed and copies given to applicant. Applicant was reminded 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.
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

As a result of today's there are no deficiencies cited. This home will be licensed for a small family child care as of today 45/4/2023.



An exit interview was conducted
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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