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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411364
Report Date: 10/10/2019
Date Signed: 10/10/2019 02:59:03 PM

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:YAMASHITA, MICHELLEFACILITY NUMBER:
434411364
ADMINISTRATOR:YAMASHITA, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 559-7595
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:14CENSUS: 10DATE:
10/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Michelle YamashitaTIME COMPLETED:
03:08 PM
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Licensing Program Analyst (LPA), Stephanie Rangel, conducted an annual random inspection. LPA met with licensee, Michelle Yamashita. Also present in the home were 2 helpers, 2 infant and 8 preschool age children. Days and hours of operation are Monday, Wednesday, Thursday 8:15am - 5:30pm and Tuesday and Friday from 8:15am - 3:30pm. There are 3 adults residing in the home: licensee, her husband and son. Licensee carries daycare insurance.

The indoor and outdoor areas were inspected during the inspection. Off limit area inside the home: the garage and master bathroom located in master bedroom. The entire back yard is accessible to children. Licensee's CPR/First aid is current and expires 9/24/21. Licensee has current children's roster and fire drills. LPA observed a fully charged 2A10BC fire extinguisher, functioning carbon monoxide detector, working smoke detector, barricaded fireplace, fenced backyard, and no bodies of water. Licensee states that there are no weapons in the home. Cleaning products, sharp objects, and other similar items are stored inaccessible to children. LPA and the Licensee discussed and are in compliance with immunization requirements for Licensee and staff including the regulation regarding Pertussis, Measles, and Influenza and required mandated reporter training. This home provides Incidental Medical Services – IMS Plan is on file.
A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Licensee understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians.


As a result of this inspection, no deficiencies were cited.

NOTICE OF SITE VISIT WAS POSTED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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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