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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414216
Report Date: 02/01/2021
Date Signed: 02/02/2021 06:10:31 AM

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:MARKUM, TIFFANY PENDLEYFACILITY NUMBER:
434414216
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
02/01/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tiffany MarkumTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Joe Macias conducted an announced virtual platform/ Facetime Increase of Capacity Inspection. The LPA met with the Licensee Tiffany Markum and disused the nature of today's inspection. The Licensee recently submitted an application for an increase of capacity. The Licensee is currently licensed to provide care for up to 8 children, and wishes to obtain a large license to provide care for up to 14 children. The purpose of today’s inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. Prior to today's inspection LPA Macias received an approved fire clearance from Santa Clara Fire Department Division of Fire Prevention. Todays census is 8 (7 preschool age, 1 school age). The Licensee and her husband John Markum are the only adult who reside in the home. The hours of operation are Monday - Friday, 6am - 6pm. The Licensee's CPR and First Aid are current.

LPA toured the indoor and outdoor areas of the home via Facetime during today's inspection. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's Inspection. Last fire drill was conducted on 12/9/2020. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the children in care. The home is orderly, and safe for the day care children. LPA did not observe a wall heater in the home (central heat). There is a fireplace in the living room which is barricaded. Off limit areas of the home: all bedrooms, side yard, and garage.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke, and carbon monoxide detectors. LPA did not observe any bodies of water. The Licensee states that she does not have weapons in the home. All detergents, cleaning compounds, poisons, medications, and other similar items are out of reach and inaccessible to children. Licensee states that she does not administer medications at this time.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021
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: MARKUM, TIFFANY PENDLEY
FACILITY NUMBER: 434414216
VISIT DATE: 02/01/2021
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The LPA also reviewed the Child Care Program COVID-19 Self-Assessment check list with the Applicant.

LPA also went over safe sleep for infants:

· Always place infants on their backs for sleeping.


· Use a tight-fitting sheet on the crib or play yard mattress.
· Do not hang any items from the crib or above the crib.
· Keep all items out of the crib or play yard.
· Pacifiers may be used as long as they do not have items attached to them.
· Infants should not be swaddled or have any items covering them while sleeping.


A review of staff records on February 1, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. A $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected.

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

LPA conducted an exit interview with the Licensee via Facetime and advised that a Large Family Child Care Home license will be issued pending current CPR & First Aid certificate, as well as management approval. A copy of this report was provided to the Licensee via email.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021
LIC809 (FAS) - (06/04)
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