410502890-9-8-2020-05-CC-FBTQ-BTA3CY-20200908180842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 410502890
Report Date: 09/04/2020
Date Signed: 09/08/2020 06:08:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	COULSON, LARRY AND MARY		FACILITY NUMBER:	410502890
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	6	CENSUS: 5	DATE:	09/04/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Mary Coulson		TIME COMPLETED:	12:00 PM

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Licensing Program Analyst (LPA), Farhan Bashir-Tariq conducted a scheduled case management inspection for capacity increase on 9/04/20 and met with Licensee, Marry Coulson. This inspection was conducted via face time due to COVID-19. Purpose of the inspection was explained. Present there were five children in care. All adults living or working in the home have fingerprints clearance on file. Hours of operation are: M-F, 7:00 AM – 5:00 PM. Licensee provides breakfast, lunch and two snacks.

LPA and Licensee inspected the entire day care area for Health and Safety hazards. LPA observed that off limit areas were properly barricaded and made inaccessible to the children in care. There were multiple carbon monoxide detectors and smoke detectors available in the home. Licensee performed test to check the functionality of detectors. A Fire Extinguisher of size 2A10BC or bigger and a working telephone was also available in the home. First Aid kit is fully stocked and accessible. Per Licensee, there are no firearms or weapons in the home. Licensee states, there are no bodies of water in the home. Per Licensee, there are not pets in the home. Back yard playground is also licensed to be used for children in care. LPA observed that back yard is fully fenced all around. License and a copy of parents’ rights poster were observed posted in the home. Per Licensee, chemicals are stored in kitchen cabinet under sink. Cabinet with chemicals was secured with a key lock. LPA received fire clearance from Redwood City Fire Department, which was granted on 8/26/20.

Both Licensees have current and valid CPR and First Aid cards expiring on July 7, 2021. LPA informed Licensee that all children and adults file shall be kept updated at all times. During the visit, LPA also provided information and assistance about issues related to COVID-19. Licensee was reminded to clean and disinfect the home thoroughly at least once a day. LPA encouraged Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. Facility can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

Large Family Child Care Home license will be recommended for approval as of today, September 4, 2020.

This report and rights to comment and appeal were discussed with Licensee. This report must be available in the facility for public review. Licensee was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For Rules and Regulations, visit the Website: www.cdss.ca.gov

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Farhan Bashir-Tariq	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2020

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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