434413739-3-12-2025-07-CC-JBER-DEPQJ3-20250312121203

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413739
Report Date: 03/12/2025
Date Signed: 03/12/2025 12:12:19 PM

Document Has Been Signed on 03/12/2025 12:12 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/ DIRECTOR:	KRISTIN & JEFFREY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 568-5484
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95118
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	03/12/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	Kristin & Jeffrey Baxter		TIME VISIT/ INSPECTION COMPLETED:	12:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Jennifer “Jen” Beehler, met with Licensees, Kristin and Jeffrey Baxter, for an unannounced Annual/Random Inspection. LPA was granted access to the home by the Licensee and toured both indoors and outdoors during the inspection. Upon arrival, there were 8 children (4 preschool age/ 4 infants) and 3 staff (2 licensees and one helper) present, which is compliant with the home license capacity and ratio requirements. LPA observed all required postings near the entrance to the home. Hours of operation for the facility are Monday – Friday, 06:30AM-06:00PM. There are no active waivers. Licensee states that adults, over the age of 18, residing in the home are: herself and her spouse (Jeffrey). licensees' infant grandson (Stephen) also lives in the home. All adults residing in the home have Criminal Background Check Clearance and signed Criminal Record Statements (LIC508). 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. LPA reviewed facility roster (LIC9040) and fire/disaster drill log during todays inspection. The last fire/disaster drill was conducted on 02/20/2025, which is compliant with the six month requirement for homes. LPA observed a fully charged 3A40BC fire extinguisher that was purchased in 2024 which is compliant with State Fire Marshal regulations, along with a functioning smoke detector and carbon monoxide detector. Licensee states that she does not currently have any children in care who require Incidental Medical Services. 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/.

Gladys Kuizon	TELEPHONE: (510) -56-5850
Jennifer Beehler	TELEPHONE: (408) 324-2148
	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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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Document Has Been Signed on 03/12/2025 12:12 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: 03/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 files which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/26/2025
	Plan of Correction
1 2 3 4	Licensees to complete an in-person EMSA approved Adult & Pediatric CPR course and provide LPA with proof of certificate.

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 4 out of 4 files which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/14/2025
	Plan of Correction
1 2 3 4	Licensees to complete LIC9227 with parents and provide LPA with photographic proof they are complete based on child's development stage.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Gladys Kuizon	TELEPHONE: (510) -56-5850
Jennifer Beehler	TELEPHONE: (408) 324-2148
	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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: 03/12/2025

NARRATIVE

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Indoor areas of the home were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Off-limits areas of the home (indoors): 3 bedrooms, kitchen, living room, and master bathroom. There are no open-faced heaters in the home. Licensee has a fireplace that is in the in the off limits area of the home. LPA observed sufficient age-appropriate materials, toys, and play equipment in the home. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. Drinking water is readily available for children in the facility via water bottles they keep in the fridge. The day care bathroom in the home is clean, sanitary, and operable. The Licensee uses her cell phone as the facility telephone and communicates to parents via text message. The Licensee states that there are no weapons or firearms in the home.

The backyard area of the home was inspected. A white children's fence was sectioned around a smaller portion of the yard. LPA observed sufficient play equipment and supplies for the children that are in good condition and age-appropriate. Off-limit areas outside of home include: a majority of the backyard, side yard areas and front yard. No outdoor bodies of water were observed during todays inspection.

Infant Safe Sleep regulations (PIN 20-24-CCP) were discussed with the Licensee, including the Individual Infant Sleeping Plan (LIC9227). LPA reminded Licensee that infants up to 12 months of age should be placed on their back to sleep, that cribs should be free of all loose articles and hanging objects, and that infants should not be swaddled. Infants should be supervised while sleeping and documentation of sleep checks every 15 minutes should remain in the infant’s file. Documentation should include the time of the check, the infant’s physical condition, and initials of the staff member checking on the infant. For additional information, Licensee can review 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.

Continued on Page 3

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Jennifer Beehler	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC809 (FAS) - (06/04)

Page: 4 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: 03/12/2025

NARRATIVE

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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.

8 children’s files were reviewed during today's inspection for the following documents: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Immunization Records (PM286), Individual Infant Sleep Plan (LIC9227) and sleep check documentation. LPA observed all 4 infants missing a completed LIC9227. All infants had infant sleep logs. LPA did not observe immunization records transferred to the PM286. LPA reminded licensee.

3 staff files (2-Licensees/ 1- Staff) were reviewed. Employee Rights (LIC9052), Criminal Record Statement (LIC508), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). There is only one staff member present with current CPR/First-Aid that expires 06/01/2025 and they are not the licensee. Licensees were reminded to complete an in-person EMSA approved CPR training course and provide the Department with proof of completion. The Licensees has current Mandated Reporter Training that expires on 08/17/2025 and LPA reminded that training must be renewed by all staff every 2 years.

Supervision of children was discussed with the Licensee and she understands that she must be home during day care hours and ensure that children are supervised at all times. The Licensee states that she does not transport any day care children. LPA reminded Licensee that children should 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 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.

Continued on Page 4

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Jennifer Beehler	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC809 (FAS) - (06/04)

Page: 5 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: 03/12/2025

NARRATIVE

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As a result of todays inspection, 2 Type B deficiencies were cited, more information on the attached LIC809-D. Exit interview conducted with Licensee, Kristin Baxter, report reviewed and provided along with appeal rights.

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

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.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) -56-5850
LICENSING EVALUATOR NAME: Jennifer Beehler	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC809 (FAS) - (06/04)

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