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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434402611
Report Date: 06/13/2024
Date Signed: 06/13/2024 10:49:57 AM


Document Has Been Signed on 06/13/2024 10:49 AM - 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:ANDERSON, COLLEENFACILITY NUMBER:
434402611
ADMINISTRATOR:ANDERSON, COLLEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 505-4257
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY:14CENSUS: 6DATE:
06/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Colleen AndersonTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Mel Matos met with Colleen Anderson, Licensee, for an unannounced Annual/Random inspection. LPA was granted access to the home by the Licensee. LPA notes that the Licensee resides in the Silicon Valley Village Mobile Home Park and public parking is available within the complex. LPA also observed six day care children and one adult assistant (Samantha Blanchard) in the home during today's inspection. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the day care area. Days and hours of operation are Monday - Friday from 6:00 AM to 6:00 PM. The adults residing in the home are: Licensee and Licensee's spouse.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on April 10, 2024. Licensee states that she does have liability insurance for the day care through DCI Insurance and LPA observed a valid policy verifying coverage through October 2024. Licensee has current CPR and First Aid certifications (exp: 08/18/2024). Licensee has the required vaccines (MMR, Tdap, & flu) and is current with her Mandated Reporter Training for Child Care Workers (exp: 01/15/2026). Licensee's adult assistant also has the required vaccines (MMR, Tdap, & flu), valid CPR/First Aid certifications (exp: 12/19/2025), and is current with the Mandated Reporter Training for Child Care Workers (exp: 01/22/2025). LPA reviewed five children's files and the files were complete with the required forms. LPA reviewed two staff files (Licensee & Licensee's assistant) and the files were complete with the required forms.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home. The home is clean, orderly, (including heating/air conditioning /ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. There are no fireplace/wall heater units or stairs inside the home. Off limit areas inside the home: master bedroom, master bathroom, and bedrooms 1 & 2. Off limit areas outside the home: right side of the house (carport), dog yard, and two storage sheds located at the back section of the backyard.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. Licensee states that she does not have any weapons in the home. The Licensee has one caged rabbit and two dogs (Chihuahua & Borderdoodle) in the home. LPA reminded the Licensee that all pet food must be inaccessible to the day care children at all times. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. Licensee states that there are no poisons in the home.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ANDERSON, COLLEEN
FACILITY NUMBER: 434402611
VISIT DATE: 06/13/2024
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Licensee states that she provides all meals for the children ( AM/PM snacks & lunch). Licensee states that all food brought from home is labeled with each child's name and properly stored. Licensee has a first aid kit in the home which includes a touch less thermometer. Licensee states that nobody smokes and she understands that smoking is prohibited in the home.

Licensee states that she does not administer any medications to the day care children. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee understands her capacity/ratio options and she understands that she cannot have more than 14 children present in the home without two qualified adults present. Licensee states that a child will be isolated in the living room area if necessary due to illness or communicable disease. Licensee states that does not transport any day care children. Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

Colleen Anderson, Licensee, was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with the 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 the 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.

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



Exit interview conducted and report was reviewed with the Licensee, Colleen Anderson. No deficiencies issued during today's inspection. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
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