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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413739
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:46:39 PM


Document Has Been Signed on 08/28/2024 04:46 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 & JEFFREYFACILITY NUMBER:
434413739
ADMINISTRATOR:KRISTIN & JEFFREYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 568-5484
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:14CENSUS: 6DATE:
08/28/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Kristin BaxterTIME COMPLETED:
04:50 PM
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Licensing Program Analysts (LPAs) Jennifer “Jen” Beehler and Samantha Yip were granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. There were six (6) children three (3) preschool-age, two (2) infants, one (1) school-age). Also in the home was the licensee, and her Spouse (Jeffrey) present, which is compliant with the home license capacity and ratio requirements. Licensees' infant grandchild is currently living in the home. LPAs observed all required postings near the entrance to the home and the hours of operation are Monday – Friday, 6:30AM-6:00PM.

The Licensee states that adults, over the age of 18, residing in the home are: licensee and her spouse (Jeffrey). There is also a tenant (Yauheni) that lives in the adjacent studio attached to the property, but with a separate entrance and no contact with the children. All adults residing in the home have Criminal Background Check Clearance and proof of negative TB test.

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.

LPAs reviewed facility roster (LIC9040) and it was up to date. The fire/disaster drill log during today’s inspection was observed. The last fire drill was conducted on 7/07/2024, which is compliant with the six-month requirement for homes. LPAs observed a fully charged 3A40BC fire extinguisher, which was serviced 10/05/2022, which was not complaint with the Fire Marshall requirement of servicing a fire extinguisher every year. A functioning smoke detector and carbon monoxide detector were observed and tested. The 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. The Licensee states that there are no weapons or firearms in the home.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
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: 08/28/2024
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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/.

Indoor areas of the home were inspected by the LPAs today and observed to be clean, orderly, and safe for the day care children. Off-limits inside the home include: three (3) bedrooms, kitchen, and laundry room. The kitchen was open to the dining room which is accessible to children. LPAs observed sharp objects in some of the lower cabinets which was removed during the visit. LPAs discussed blocking off the area with the licensee, she advised she would order a fence to keep the kitchen inaccessible from the children. There are no open-faced heaters in the home. The fireplace has a metal insert covering the opening. LPAs observed sufficient age-appropriate materials, toys, and play equipment in the home. Drinking water is readily available for children via water bottles and sippy/plastic cups. The bathroom in the home is clean, sanitary, and operable. The Licensee has a working telephone (cell phone) in the home. The Licensee states that she provides the children with AM/PM snacks and lunch. The refrigerator was clean and items checked were not expired.

The backyard area of the home was inspected and observed to be fenced in. LPAs observed sufficient play equipment and supplies for the children that are in good condition and age-appropriate. Off-limit areas outside of home include: backyard area outside of the fenced area for children. There are plastic kitchen structures, chairs, and small toys for the children to play with. There is an umbrella for shade. No outdoor bodies of water were observed during today’s inspection. There was a bench with storage below located in the children's play area that included hazardous materials such as paint. The bench was closed, but not locked. Licensee locked the bench during the visit.

LPAs discussed the safe sleep regulations with licensee. LPAs observed a loose sheet on one of the cribs. Licensee replaced with a fitted clean sheet. Licensee currently has 2 infants in care under 12 months old. Neither infant had a sleep plan LIC 9227 in the file. LPAs 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. LPAs 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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: 08/28/2024
NARRATIVE
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Six (6) children’s files were reviewed during today’s inspection and all required documents were present. The sleep check log was available for review and complete. LPAs reminded the Licensee to fill out all fields on the paperwork provided to parents and to regularly update immunization record for children in care.

Licensees files were reviewed, and most required documents were present. The Licensee has current CPR/First-Aid that expires 09/19/2025. The certificate does not have EMSA stamp and therefore could not be verified. Licensee advised she would reach out for clarification to determine if it was an acceptable class based on requirements. Mandated Reporter Training was completed by both licensees. Jeff's expires 08/17/2025 and Kristin's expires on 08/16/2025. LPAs reminded that training must be renewed by licensees every 2 years.

The Licensee states that she does not transport any day care children. LPAs reminded Licensee that a valid driver’s license is required to transport children and that children should not be left unattended in parked vehicles. Licensee was also reminded that car seats shall only be used for transportation and shall not be used for sleeping.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders (RSO) living in the facility and LPA completed the RSO profile and determined no sex offenders are associated with the facility address.

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-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: 08/28/2024
NARRATIVE
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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.

Based on LPAs observations, three (3) type B citations were issued during today's visit. A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with the licensee, Kristin Baxter.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 08/28/2024 04:46 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to accessible paints in the bench in the outdoor child's play area, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/28/2024
Plan of Correction
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Deficiency has been corrected during today's inspection. Licensee locked the bench.
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to the sheet being loose, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/28/2024
Plan of Correction
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Deficiency was corrected during today's visit. Sheet was replaced with a tightly fitted clean sheet.
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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 08/28/2024 04:46 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 infants which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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LIC 9227 to be created for both infants and placed in the file. Deficiency was cleared for one infant during today's visit.
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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Jennifer BeehlerTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
LIC809 (FAS) - (06/04)
Page: 6 of 6