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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270766992
Report Date: 03/04/2025
Date Signed: 03/04/2025 03:44:51 PM

Document Has Been Signed on 03/04/2025 03:44 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ALLEN, KATHYFACILITY NUMBER:
270766992
ADMINISTRATOR/
DIRECTOR:		KATHY ALLENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 455-5232
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Allen, KathyTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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On the above date, Licensing Program Analyst (LPA) Liridon Fici (Doni) arrived unannounced to conduct an Annual inspection and was greeted by Licensee, Allen, Kathy. LPA also informed Licensee the purpose of today’s visit.

During visit, there were two (2) staff, and 12 children present. Licensee stated that she is the only adult residing at the home. All are fingerprint cleared and associated to the facility. LPA observed 3 children under 2 years and 9 children over 2 years old; A review of children roster indicated (3 infants). LPA advised that children living in the home will be included in the home ratio and capacity until they turn 10 years of age.

The day care is located off the dinning room of the house towards the backyard. Parents will enter from the front of the house. The front part of the home is off limits from the day care. The home has no stairs going up to the second floor. Days and hours of operation are Monday - Friday from 7:30 AM to 5:30 PM. LPA reviewed Fire/Disaster drill log during today's inspection was conducted on 2/14/2025.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee’s has a working cell phones in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. The backyard is enclosed by a fence.

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Gladys KuizonTELEPHONE: (510) 566-5850
Liridon FiciTELEPHONE: 408-598-9250
DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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 03/04/2025 03:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: ALLEN, KATHY
FACILITY NUMBER: 270766992

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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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2
3
4
Based on record review, the licensee did not comply with the section cited above by not having current mandated reporting training for Staff 1 and staff 2 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/14/2025
Plan of Correction
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Licensee agreed to send proof of mandate reporting training for Staff 1 and staff 2 to CCL by POC due date
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on record review, the licensee did not comply with the section cited above by not maintaining valid first aid/ CPR for Staff 1 and staff 2 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/14/2025
Plan of Correction
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2
3
4
Licensee agreed to send proof of First aid/CPR training for Staff 1 and staff 2 to CCL by POC due date
Licensee stated First aid/CPR has been scheduled for 3/12/2025 at 5:30PM
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys KuizonTELEPHONE: (510) 566-5850
Liridon FiciTELEPHONE: 408-598-9250

DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ALLEN, KATHY
FACILITY NUMBER: 270766992
VISIT DATE: 03/04/2025
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Off limit areas inside Licensee's home: Office, laundry room, garage and master bedroom. Off limits to the outside home include: Right side of the backyard. LPA toured the backyard area and observed the backyard area is adequately fenced and there are no bodies of water. There is a designated area in the living room where the kitchen is located where child(ren) can be isolated if exhibiting any signs of illness until the child's parent(s) pick them up.

Licensee provides breakfast, lunch, and snacks; licensee will prepare and cook meals for children. LPA observed a first aid kit in the day care. Staff stated that nobody smokes, and she understands that smoking is prohibited in the day care. LPA observed a fully charged 2A10BC fire extinguisher last time serviced on 2.6.2024, with working smoke and carbon monoxide detectors. The Licensee stated that there are no weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children.


Licensee and Staff files were reviewed for the following records: Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). Licensee has a current Mandated Reporter Training and was conducted on 7/19/2024. Licensee has current Pediatric CPR/FIRST AID that was conducted on 3/2024. LPA informed Licensee that Mandated reporting and First aid/CPR is mandatory and should be renewed every 2 years.

LPA reviewed a selection of five (5) children's file and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file.

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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ALLEN, KATHY
FACILITY NUMBER: 270766992
VISIT DATE: 03/04/2025
NARRATIVE
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Incidental Medical services (IMS) policy was discussed. Licensee does not handle any medications. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417 and 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: http://www.ada.gov/childqanda.htm. Licensee does not give medication to children at the moment. A plan will be submitted later in the future if needed.

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 Licensee 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.

Supervision of children was discussed with licensee, and she understands that she must be present in the home during day care hours and ensure that the children are always supervised. Licensee understands her capacity options and she understand that she cannot have more than 14 children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.


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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ALLEN, KATHY
FACILITY NUMBER: 270766992
VISIT DATE: 03/04/2025
NARRATIVE
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LPA discussed the requirements of AB 633 with the Licensee and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

The licensee 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.

The following type B deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.



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

Exit interview conducted with Licensee, and a copy of this review was reviewed and provided along with appeal rights










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SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Liridon FiciTELEPHONE: 408-598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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