434408470-5-18-2022-07-CC-OCAO-CEJPXV-20220518114258

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408470
Report Date: 05/18/2022
Date Signed: 05/18/2022 11:43:07 AM

Document Has Been Signed on 05/18/2022 11:43 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	WOOD, HEATHER		FACILITY NUMBER:	434408470
ADMINISTRATOR:	WOOD, HEATHER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 266-6497
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	14	CENSUS: 8	DATE:	05/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Heather Wood		TIME COMPLETED:	12:00 PM

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Licensing Program Analyst (LPA) Ofelia Calivo met with Licensee Heather Wood for an unannounced Required - 1 Year Inspection. Also present in the home were Licensee's assistant, Samantha Garcia, and eight daycare children. LPA was granted access to the home by the Licensee and toured both indoor and outdoor areas during the inspection. LPA observed all required posted materials. Days and hours of operation for the facility are Monday through Friday from 7:30 AM to 5:30 PM. Facility has an active waiver on file for trampoline use in the outdoor yard. Licensee states that she’s the only adult living in the home.

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 reviewed and obtained a copy of facility roster (LIC 9040). Fire/disaster drill was conducted on March 16, 2022. LPA observed a fully charged 3A40BC fire extinguisher which was last serviced on February 2, 2022, and functioning smoke and carbon monoxide detectors. Licensee states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. Licensee states that there are no weapons or firearms in the home.

Indoor licensed areas of the facility were inspected by LPA today and observed to be clean, orderly, and safe for the day care children. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters or fireplace units inside the home.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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: WOOD, HEATHER	FACILITY NUMBER: 434408470
	VISIT DATE: 05/18/2022

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Off limit areas in the home are: all bedrooms, bathroom downstairs, entire upstairs and attached garage. The outdoor space and play equipment were observed to have been maintained in safe condition and free of hazards. Facility appeared to be free of flies, other insects, and rodents during today’s inspection. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture such as tables, chairs, couches, and shelves are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children in the facility via individual sippy cups. The home has a working telephone which is (408) 266-6497.

The outdoor licensed areas of the home were inspected and observed to be fenced in. No off-limit areas outside the home. There were no bodies of water observed.

Eight children’s files were reviewed during today’s inspection for the following records: Notification of Parents Rights (LIC 995A), Consent for Emergency Medical Treatment (LIC 627), Identification and Emergency Information (LIC 700), and Immunization Records. Licensee carries daycare insurance.

LPA reviewed one Assistant’s file for the following records: Criminal Record Statement (LIC 508), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee Rights (LIC 9052), Immunization in measles, pertussis and flu, and Mandated Reporter Training. Licensee has Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and flu. The Licensee has current Mandated Reporter Training certificate. Licensee's CPR/First-Aid expires on June 30, 2023. LPA reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years.

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 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.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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: WOOD, HEATHER	FACILITY NUMBER: 434408470
	VISIT DATE: 05/18/2022

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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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Exit interview conducted and report was reviewed with the Licensee Heather Wood.

There are no deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

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