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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407129
Report Date: 10/22/2021
Date Signed: 03/26/2024 04:30:54 PM


Document Has Been Signed on 03/26/2024 04:30 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:TASHIRO, NARUMIFACILITY NUMBER:
434407129
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Narumi Tashiro TIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Stephanie Collins conducted an unannounced Annual Inspection of the Family Day Care home. LPA met with Licensee Narumi Tashiro and explained the purpose of the inspection. One year annual and licensee requested to increase capacity from a small Child Care Family Home to a Large Child Care Family Home (FCCH) . Present were 3 children in care. Licensee followed capacity requirements for a Small Family Child Care Home License. Licensee lives in the home her husband (

The home’s operating days and hours are Monday through Friday 7:30 AM to 5:30 PM. Facility maintains telephone service. Facility’s License and Notification of Parents’ Rights were observed to be posted. LPA discussed with Licensee about the personal rights of children, Large Family Child Care ratio and capacity.

LPA inspected the indoor and outdoor areas of the home with Licensee. The home was clean with heating and ventilation for the safety and comfort of children in care. LPA did not observe flies, other insects, or rodents during today’s inspection.

LPA observed children’s toys play equipment and materials were in good condition. There were no baby walkers observed. Bathroom for children's use was sanitary. FCCH compliance with COVID-19 Guidelines and

Off Limit areas are all three bedrooms, Master bathroom, Office Room, Laundry area and the Garage. The backyard is fenced and is used for outdoor activity. The trampoline in the backyard was inspected. LPA also went over with Licensee the stipulations of the waiver granted to Licensee on 09/25/2013 to allow children in care to use the trampoline.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TASHIRO, NARUMI
FACILITY NUMBER: 434407129
VISIT DATE: 10/22/2021
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There were no bodies of water observed. Licensee stated that there were no weapons such as firearms stored on the premises. Licensee has a small sized pet dog that is kept inside the home and is allowed to be in contact with children in care. Per Licensee, the dog is up to date with vaccinations.
The home has a fully charged Fire extinguisher. Carbon monoxide and smoke detectors were tested and proved to be functioning. Fire inspection was completed on 10/18/2021 Log shows that Disaster Drill was last conducted in May/19/2021.
Licensee stated that she does not transport children at this time, but Licensee understands that children cannot be left alone, unattended in parked vehicles at any time.

Facility's roster and Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Immunization.

Licensee's file was reviewed, which included records of Criminal Record and Child Abuse Index Clearance, TB clearance, documentation for Immunization against Measles and Pertussis, and Training. Licensee's Pediatric First Aid and CPR certification expires 07/2023

Adults who are over the age of 18 and reside in the home are the Licensee and Licensee's Spouse
(Akira Tashiro) and Daughter (Emily Tashiro). They have Clearance for Tuberculosis and Criminal Record and Child Abuse Index Background Check.

LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day, up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day, up to $3000.00 per person.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TASHIRO, NARUMI
FACILITY NUMBER: 434407129
VISIT DATE: 10/22/2021
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Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors, and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at:
https://www.mandatedreporterca.com/

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, etc.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that currently she does not have any children in care who requires IMS. 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.

Family Child Care Homes
Licensee Narumi Tashiro 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.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TASHIRO, NARUMI
FACILITY NUMBER: 434407129
VISIT DATE: 10/22/2021
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Safe Sleep
LPA discussed the safe sleep regulations with licensee Narumi Tashiro and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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. LIC 126 Entrance Checklist-completed and COVID-19 self-Assessment completed.

The request for an increase in capacity from a small to Lrge Family Care Home is approved pending Management's final review and approval and any required document (s).

1: Pending : Fire Clearance report.

NO Deficiencies identified during inspection.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
LIC809 (FAS) - (06/04)
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