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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010204748
Report Date: 10/24/2023
Date Signed: 10/24/2023 02:38:42 PM

Document Has Been Signed on 10/24/2023 02:38 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CADMAN, SHELLEYFACILITY NUMBER:
010204748
ADMINISTRATOR:CADMAN, SHELLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 524-6865
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Erica PaizTIME COMPLETED:
02:50 PM
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On Tuesday, October 24th at 10:15AM Licensing Program Analyst (LPA) Brittany Crass, and Licensing Program Manager, Loretta Dyson (LPM), arrived at the home for an unannounced Required - 1 year inspection. LPA was greeted by licensee, Shelley Cadman on the porch, and was welcomed into the facility, and met with an employee named Erica Paiz. The licensee is on vacation, but still at the home. There were 0 infants and 10 pre-school aged children in care during the inspection. There were also 2 additional employees working at the time of the inspection. This family childcare home operates Monday - Friday 8am-5:30pm. LPA verified that the licensee's email address on file is correct, however, the phone number has been updated.

The home is a 2 story home. The entire upstairs is off limits and consists of 3 bedrooms, 1 bathroom, a living room, and kitchen. The downstairs basement area is the main area used for childcare and consists of on limits areas: 3 play areas, a bathroom, a kitchen area, and an office used for school aged children. The off-limits areas downstairs include a storage room. There is also an on limits fully fenced, outside play area that includes a separate wooden structure that is used as an art room, secured play structures, and a sandbox. The off-limits areas outside include a storage room. LPA toured the on-limit areas used for childcare to conduct a health and safety inspection. LPA observed that the home has heating and ventilation for the safety and comfort of children in care. The off limits areas are made inaccessible by closed and/or locked doors, child proof door knobs, gates, and visual supervision. LPA didn't observe any hazardous items in lower cabinets that are accessible by children. If weather permits, the outside bench, near the door, is used for isolation of sick children, away from other children in care. If weather does not permit, the office area inside is used as the isolation area, with the supervision of a teacher. LPA did not observe any hazards or dangerous conditions in the yard. LPA observed an ample supply of age-appropriate toys, equipment and activities available for children both indoors and outdoors and observed that they are in good condition. LPA did not observe any bodies of water, toxins, or hazardous items that would be accessible to children. The employee stated that there are no firearms on the premises.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CADMAN, SHELLEY
FACILITY NUMBER: 010204748
VISIT DATE: 10/24/2023
NARRATIVE
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The home is equipped with at least one fully charged 3A40BC fire extinguisher, a working combination carbon monoxide detector/smoke detector, working telephone, and first aid kit. Licensee has proof of current CPR/First aid certificates, which expire on 7/2025. Facility did not have a fire drill log, although the employee stated that they conduct one every 3 months. LPA observed all of the required forms posted. LPA reviewed children's files, staff files and requested a copy of the current roster.

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 [email protected]. 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.

The assistant 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.

Licensee does not accept any infants under 2 years old, so safe sleep was not reviewed.

LPA reminded the assistant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family childcare homes. LPA provided the main office number for the Oakland Regional Child Care office (510) 622-2602 for the licensees to call and report injuries or unusual incidents and reviewed the form to follow up in writing within 7 days of the injury/unusual incident. The assistant was encouraged to remind the licensee to periodically review regulations, guidelines and Provider Information Notices (PINs) on the website www.ccld.ca.gov.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CADMAN, SHELLEY
FACILITY NUMBER: 010204748
VISIT DATE: 10/24/2023
NARRATIVE
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies. LPA observed that there was medication that was not labeled and the assistant confirmed that there was no paperwork from the medical provider or parent. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

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

During the exit interview, the assistant confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA reminded the licensee that the mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. The licensee's training certificate expired on 5/02/2020. Employee Erica Paiz certificate was not in the file, and another employees certificate expired on 5/27/2020.

A notice of site visit was given and must remain posted for 30 days.

Appeal Rights were provided. See LIC 809-D for deficiencies being sited today.

Exit interview conducted and report was reviewed with the assistant.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Brittany Crass
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 10/24/2023 02:38 PM - It Cannot Be Edited


Created By: Brittany Crass On 10/24/2023 at 01:45 PM
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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CADMAN, SHELLEY
FACILITY NUMBER: 010204748

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on review of records, 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. They did not have a copy of the log.
POC Due Date: 11/22/2023
Plan of Correction
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They agreed to complete a fire drill/earthquake drill every 6 months, and to send in a log by 11/22/23.

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:Loretta Dyson
LICENSING EVALUATOR NAME:Brittany Crass
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/24/2023 02:38 PM - It Cannot Be Edited


Created By: Brittany Crass On 10/24/2023 at 01:45 PM
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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CADMAN, SHELLEY
FACILITY NUMBER: 010204748

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2023

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
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Based on records review, the licensee did not comply with the section cited above in 3 out 4 records was not updated to have current certificates, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2023
Plan of Correction
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Staff members need to complete the training and send in copies of the certificates by 11/22/23.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in 2/4 staff records do not include all required immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2023
Plan of Correction
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Staff member will submit proof of all required immunizations that are not in the files by 11/22/23.
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:Loretta Dyson
LICENSING EVALUATOR NAME:Brittany Crass
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 10/24/2023 02:38 PM - It Cannot Be Edited


Created By: Brittany Crass On 10/24/2023 at 01:45 PM
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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CADMAN, SHELLEY
FACILITY NUMBER: 010204748

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 3 immunization records were not included in the file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2023
Plan of Correction
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Staff member will obtain childrens immunization records and will send in a copy of the record added to the file by 11/22/23.
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3/3 childrens files do not include the signed affidavit, and the licensee was unable to provide proof of current insurance, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2023
Plan of Correction
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Licensee will either provide proof of liability insurance, by sending us a copy, or will add the LIC 282 to each childs file, by 11/22/23.
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:Loretta Dyson
LICENSING EVALUATOR NAME:Brittany Crass
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023


LIC809 (FAS) - (06/04)
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