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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403665
Report Date: 10/12/2023
Date Signed: 10/13/2023 01:02:11 PM

Document Has Been Signed on 10/13/2023 01:02 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MATTHEWS, MALINDAFACILITY NUMBER:
434403665
ADMINISTRATOR:MATTHEWS, MALINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 759-8555
CITY:SAN JOSESTATE: CAZIP CODE:
95121
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 1DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Malinda MatthewsTIME COMPLETED:
05:00 PM
NARRATIVE
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On 10/12/2023 at 1:45pm, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Malinda Matthews and explained the nature of today’s inspection. Present in the home were licensee, daughter/assistant, Sonya Matthews, and 1 preschool child. Licensee was operating within the ratio and capacity requirements of the license. Days and hours of operation are Monday to Friday, 7:00 am to 5:30 pm. LPA observed all required posted materials near the front entrance to the home. The adults that reside in the home are licensee, spouse and daughter. Licensee has no minor children residing in the home. Licensee stated that her son is visiting and is only staying for the week.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-691-1847). LPA observed sufficient materials, toys, and play equipment for the day care children. Furniture, such as tables, chairs, crib and shelves, are in good condition. The floors were free of tripping hazards with toys put away on shelves. The home has central heating/cooling and ventilation for comfort of children. The home is multi story and LPA did not observe barricaded stairs to the upper and lower level during today's inspection. Licensee installed barricades on both staircases while LPA was present. LPA observed a barricaded fireplace in the off-limits den area. LPA observed that the bathroom used by children was in operating condition. Toilets and faucet are clean and operable. LPA observed child proof locks on cabinets under the bathroom sink to secure areas that are to be inaccessible to children. Off limit areas inside the home: entire upstairs, kitchen, den, laundry room and attached garage. Off limit areas outside the home: entire backyard excluding the children's play area on the right side section of the home. LPA observed that the hot tub in the cabana room is drained and is being used for storage. Licensee informed LPA that she plans to have the hot tub removed and clear the space. Backyard is fenced and both sides of the home are gated. The outdoor space and play equipment were observed to be age appropriate. There are no bodies of water observed.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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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Document Has Been Signed on 10/13/2023 01:02 PM - It Cannot Be Edited


Created By: Farida Raja On 10/12/2023 at 04:05 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MATTHEWS, MALINDA
FACILITY NUMBER: 434403665

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/12/2023
Plan of Correction
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Licensee installed barricades on two staircases while LPA was present. This citation was cleared during today's visit.
Type B
Section Cited
CCR
102417(g)(9)(A)
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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/26/2023
Plan of Correction
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Licensee will conduct and document Fire/ Disaster drills with children in care and submit proof to LPA by plan of correction date of 10/26/2023.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


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Document Has Been Signed on 10/13/2023 01:02 PM - It Cannot Be Edited


Created By: Farida Raja On 10/12/2023 at 04:05 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MATTHEWS, MALINDA
FACILITY NUMBER: 434403665

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

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 observation, interview and record review, the licensee did not comply with the section cited above for one staff which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/26/2023
Plan of Correction
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Licensee will have daughter/assistant complete the Mandated Reporter training and submit certificate of completion to LPA by plan of correction date of 10/26/2023.
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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Based on observation, interview and record review, the licensee did not comply with the section cited above for herself which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/26/2023
Plan of Correction
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Licensee will complete the Pediatric CPR/First Aid training and submit proof of completion to LPA by plan of correction date of 10/26/2023.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MATTHEWS, MALINDA
FACILITY NUMBER: 434403665
VISIT DATE: 10/12/2023
NARRATIVE
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LPA observed a fully charged 3A40BC fire extinguisher in the living room area and working smoke/carbon monoxide detectors. The Licensee states that she does not have any weapons. Licensee stated that she has one pet cat. All detergents, cleaning compounds, sharp objects and other similar items were observed to be stored inaccessible to children in high kitchen cabinets. Licensee understands that smoking is prohibited in the home.

Drinking water is readily available for children in the home via individual water bottles. Licensee states that she provides meals and snacks to the children in care. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored or refrigerated.

LPA reviewed a current Child Care Facility Roster. LPA obtained copy of children's roster.
Licensee has not conducted and documented Fire/Disaster drills. LPA informed licensee that fire drills need to conducted every 6 months and a log needs to be maintained at the facility.

Children file review was completed and found to be current and up to date. Five (5) children’s files were reviewed during today's inspection. Licensee carries daycare insurance and LPA observed a current policy verifying valid coverage.

LPA discussed the safe sleep regulations with licensee, including conducting 15-minute checks on all sleeping infants 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. LPA provided licensee with a copy of an Individual Infant Sleeping Plan (LIC 9227) for infants 12 months and under and a sample 15- minute sleeping infant check form for children under 2 years of age.

LPA reviewed two (2)staff files (Licensee and assistant) for the required forms. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA confirmed through file review that licensee did not have valid CPR/First Aid Training and assistant did not have valid Mandated Reporter

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MATTHEWS, MALINDA
FACILITY NUMBER: 434403665
VISIT DATE: 10/12/2023
NARRATIVE
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Training. Licensee has completed the Mandated Reporter Training which expires on 04/12/2025. Licensee understands the training is mandatory to all Licensees and adults in the home in contact will children and requires renewal every two years. LPA referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training. Licensee and assistant have the required immunization in file for measles, pertussis and influenza/statement declining influenza.

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.

Supervision of children was discussed with Licensee, and she understands that she or a qualified adult must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

LPA discussed "zero tolerance" related regulations which includes the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Licensee is encouraged to visit the Department’s website at https://cdss.ca.gov/inforesources/child-care-licensing to access general updates, resources for providers, regulations, adoptions of new laws, pay annual fees etc.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she is not providing any medication to children at this time. 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

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MATTHEWS, MALINDA
FACILITY NUMBER: 434403665
VISIT DATE: 10/12/2023
NARRATIVE
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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/.

Licensee states that she does not transport any day care children. LPA reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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.

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

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.

Five (5) Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights were printed and provided to Licensee. LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation. Exit interview conducted and report was reviewed with the licensee, Malinda Matthews.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 10/13/2023 01:02 PM - It Cannot Be Edited


Created By: Farida Raja On 10/12/2023 at 04:08 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MATTHEWS, MALINDA
FACILITY NUMBER: 434403665

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8595(d)(3)
1596.8595 Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services

(d) (3) The licensee shall require each recipient of the licensing document pertaining to a conference to sign a statement indicating that he or she has received the document and the date it was received.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. A Decision and Order (D & O) effective 08/31/2020 and in effect for 3 years, listed on Page 10 that licensee shall provide current and prospective parents a copy of the D & O and maintain a signed acknowledgement in each child's file.
POC Due Date: 10/26/2023
Plan of Correction
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Licensee will provide a writted plan of correction to ensure that parents are provided required notifications and licensing reports as per department regulations. Licensee will provide the plan of correction to LPA by 10/26/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


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