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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625549
Report Date: 01/30/2024
Date Signed: 01/30/2024 03:42:51 PM

Document Has Been Signed on 01/30/2024 03:42 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HARRIS, SHALYNNFACILITY NUMBER:
343625549
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
01/30/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shalynn HarrisTIME COMPLETED:
11:30 AM
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This is a Change of Location from previous facility number 343624929.
On Tuesday, January 30, 2024, Licensing Program Analysts (LPAs) Tanya Washington and Loraine Perez conducted a Change of Location inspection and met with applicant Shalynn Harris (L1). LPAs conducted a health and safety inspection of L1’s home inside and out. Facility hours of operation will be 7 days a week from 5 AM until 12 AM.

Applicant rents the home, a copy of the rental agreement and signed form LIC9149 was submitted to the department. Applicant was granted permission from the landlord to watch up to eight children at one time.
L1 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.

This facility is a two story home. The first floor has an office, living room, kitchen, master bedroom, Applicant's sons bedroom, one full bathroom and one half bathroom. The second floor has two bedrooms and two full bathrooms. There is an unoccupied detached building in the backyard of the facility which will not be part of daycare. Off limit areas will include: both downstairs bedrooms, office, entire second floor, backyard and detached building in the backyard. L1 stated she understands that children may not enter off limits areas and any changes made must be cleared through Licensing. Chemicals, knives, medications, and hazardous items are all stored in a way that is inaccessible to children. LPAs advised that poisonous items must be key or combination locked. LPA observed the smoke and carbon monoxide detector are functioning properly. LPAs observed a 2A-10-BC fire extinguisher. LPAs observed proper storage of weapon and ammunition. L1 was reminded that the weapon storage will be inspected during regular annual inspections. L1 stated she understands that her own children under the age of 10 count as part of the ratio. There are no bodies of water on the premises.

Continued on LIC809C
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HARRIS, SHALYNN
FACILITY NUMBER: 343625549
VISIT DATE: 01/30/2024
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LPA discussed with L1 the safe sleep regulations and 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 L1 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.

Incidental Medical Services- IMS policy was discussed. For IMS information 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.

LPA provided the Department’s website WWW.CCLD.CA.GOV, so the L1 can obtain updated licensing information, new regulations and access forms. LPA advised L1 of their responsibility to stay current by reviewing PINs on the website.

Effective today, 01/30/2024, the new facility is licensed to operate as a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2 years.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
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