434413739-12-20-2023-07-CC-JBOT-CYQ6PM-20231220195920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413739
Report Date: 11/29/2023
Date Signed: 12/20/2023 07:59:36 PM

Document Has Been Signed on 12/20/2023 07:59 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	BAXTER, KRISTIN & JEFFREY		FACILITY NUMBER:	434413739
ADMINISTRATOR:	KRISTIN & JEFFREY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 568-5484
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY:	14	CENSUS: 7	DATE:	11/29/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kristin Baxter		TIME COMPLETED:	03:00 PM

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Licensing Program Analyst (LPA) Jessica Bongardt and Licensing Program Manager (LPM) Gladys Kuizon met with Licensee, Kirstin Baxter for an unannounced Required – 3-year annual inspection. LPA and LPM were granted access to the home by the Licensee. LPA and LPM also observed seven children and husband Jeffrey Baxter, in the home during today's inspection. Licensee was operating within her capacity and ratio requirements. LPA and LPM observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday-Friday 6:30AM-6:00PM. The adults residing in the home are, Licensee and Husband, Jeffrey Baxter.

LPA and LPM reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 07/06/2023 at 3:00PM. Licensees state that they have liability insurance for the day care. Licensees have current CPR and First Aid certifications (expiration: 09/19/2025). Licensees have the required vaccines (MMR, Tdap, & flu) and are current with their Mandated Reporter Training for Child Care Workers (expiration: 08/16/2025(Kristin) 08/17/2025(Jeffrey). LPA and LPM reviewed 4 children's files and the files were complete with the required forms. LPA and LPM reviewed 2 staff files (Licensees) and the files were complete with the required forms. Licensee state that a child will be isolated in the office part of the living room or in the kitchen area until pick-up if necessary due to illness or communicable disease.

LPA and LPM 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 is safe & age appropriate toys, play equipment, and materials for the children in the home. There are no stairs inside the home. LPA and LPM did not observe any wall heaters inside the home. There was a fireplace inside the home that was blocked from the children. Off limit areas inside the home: All three bedrooms and the kitchen. Off limit area outside the home: the cottage.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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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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: BAXTER, KRISTIN & JEFFREY	FACILITY NUMBER: 434413739
	VISIT DATE: 11/29/2023

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LPA and LPM observed a fully charged 3-A-40-BC fire extinguisher, working smoke/carbon monoxide detectors, and fenced backyard. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

Licensee states that she does not administer any medications to the day care children. Licensee states that she provides meals (breakfast, snacks, and lunch) to the day care children. Licensee understands that any food brought from home it shall be 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.

The licensee understands that children's personal rights should not be violated, including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature.

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 she 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.

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/$3000.00 per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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: BAXTER, KRISTIN & JEFFREY	FACILITY NUMBER: 434413739
	VISIT DATE: 11/29/2023

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Incidental Medical Services (IMS) policy was discussed. 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 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/.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee [or 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.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

The 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.
Exit interview conducted and report was reviewed with the Licensee, Kristin Baxter. no deficiencies were 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: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

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