483003617-9-16-2024-01-CC-MAUN-D96QN7-20240916121839

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 483003617
Report Date: 09/16/2024
Date Signed: 09/16/2024 12:18:48 PM

Document Has Been Signed on 09/16/2024 12:18 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	WAHID, SHONNA FAMILY CHILD CARE HOME		FACILITY NUMBER:	483003617
ADMINISTRATOR/ DIRECTOR:	WAHID, SHONNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 435-0525
CITY:	SUISUN	STATE: CA	ZIP CODE:	94585
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 7	DATE:	09/16/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:20 AM
MET WITH:	Shoona Wahid - Licensee		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. A review of staff records on 09/16/2024 indicates not all facility staff or other individuals who require caregiver background checks received a criminal record and child abuse index clearances or exemptions. According to Licensee’s statement, adult (A1) currently resides in the home and Licensee thought A1 had obtained a criminal record clearance. Licensee furnished a copy of DOJ confirmation which showed A1 obtained a Livescan in June 2023. After further review of the matter, department records revealed A1 obtained a partial clearance and was associated, but A1 was missing CACI clearance. As such, an immediate $100 civil penalty was assessed because Licensee did not ensure A1 obtained a clearance prior to residing in the home. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. According to the Licensee, the facility was registered with the Resource and Referral Agency's, Food Program. The facility currently did not have any active/standing waivers. During today’s inspection, the home and grounds were toured. Licensee (LS) was supervising seven children and was operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The off-limits areas of the home are the entire second floor, and garage, and were made inaccessible by means of a children’s safety gates. The children have access to the playroom, family room, kitchen, and dining areas, one bathroom, and backyard. The facility’s operating hours are 7:00am to 6:00pm, Mon–Fri. The floor plan submitted by the licensees was reviewed and verified. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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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Document Has Been Signed on 09/16/2024 12:18 PM - It Cannot Be Edited

Created By: Melchisedeck Augustin On 09/16/2024 at 10:35 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WAHID, SHONNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483003617
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Licensee's statement confirming A1 resided in the home & department records reviewed which revealed A1 had not obtained a criminal record clearance. An immediate $100 Civil Penalty was assessed because Licensee did not ensure A1 obtained a criminal record clearance prior to residing in the home. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/17/2024
	Plan of Correction
1 2 3 4	Licensee stated she would ensure A1 got Livescan at a local Livescan vendor, and Licensee intends to submit a copy of the completed LIC 9163 to the department by 09/17/24. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Leslie Lepori

LICENSING EVALUATOR NAME:

Melchisedeck Augustin

LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/16/2024 12:18 PM - It Cannot Be Edited

Created By: Melchisedeck Augustin On 09/16/2024 at 10:35 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WAHID, SHONNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483003617
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on staff (LS & S1) records reviewed which revealed S1 did not have evidence of completion for AB 1207 Mandated Reporter Training. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/27/2024
	Plan of Correction
1 2 3 4	Licensee said she woule remind S1 to complete AB 1207 Mandated Reporter training at mandatedreporterca.com, and Licensee intends to submit a copy of S1's AB 1207 Mandated Reporter Training certificate to the department by 09/27/24.

Type B

Section Cited

CCR

102369(b)(9)

Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Licensee not furnishing evidence of negative Tuberculosis (TB) clearance for A1. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/27/2024
	Plan of Correction
1 2 3 4	Licensee stated she would ensure A1 obtain evidence of negative TB clearance, and Licensee intends to submit evidence of A1's clearance to the department by 09/27/24 via mail, email or fax. Email: melchisedeck.augustin@dss.ca.gov & Fax: 707-588-5099

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Leslie Lepori

LICENSING EVALUATOR NAME:

Melchisedeck Augustin

LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WAHID, SHONNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483003617
	VISIT DATE: 09/16/2024

NARRATIVE

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The home was at a comfortable indoor temperature. There were safe toys available for children. There is a working telephone in the home and the Licensee understood that the facility telephone was required to stay at the facility during operating hours. Licensee's Heart Saver Pediatric Cardiopulmonary Resuscitation (CPR) and First Aid certification expire on 01/21/25. LPA did not observe any poison(s) and according to Licensee, she did not store any firearm(s) and/or other dangerous weapon(s) on the premise. There is a functional smoke and carbon monoxide detectors, and a fully charged fire extinguisher that met the standards of the state fire marshal. LPA did not observe any bodies of water.

According to the facility disaster drill, an emergency disaster drill was conducted within six months, and the log reflected a drill was conducted on 07/05/24. The facility roster of the children in care was reviewed and appeared to be complete. The Licensee did not furnish evidence of completion of current AB 1207 Mandated Reporter Training for S1, as well as evidence of negative Tuberculosis (TB) clearance for A1. LPA reviewed five children’s records at 8:59am which contained Affidavit Regarding Liability Insurance (LIC 282), Consent for Emergency Medical Treatment (LIC 627), Identification and Emergency Information (LIC 700), Parents Rights (LIC 995A), and Immunization Records (IR). Licensee confirmed there was one child (C4) under 24 months old enrolled in care, there were two play yards available for the infant to take a nap, and Licensee furnished evidence of 15 minute checks for C4.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensees 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 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: https://www.ada.gov/resources/child-care-centers/. (Continue to LIC 809-C)

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: WAHID, SHONNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 483003617
	VISIT DATE: 09/16/2024

NARRATIVE

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On this date, 09/16/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the Licensee, Shonna Wahid. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. The following violations of California Code of Regulation(s), Title 22; Division 12, were observed during today’s visit. Appeal Rights were provided.

LPA Melchisedeck Augustin informed licensee, Shonna Wahid that this report dated 09/16/24 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Melchisedeck Augustin informed the licensee to provide a copy of this licensing report dated 09/16/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melchisedeck Augustin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC809 (FAS) - (06/04)

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