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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414311
Report Date: 04/27/2022
Date Signed: 04/28/2022 08:29:14 AM


Document Has Been Signed on 04/28/2022 08:29 AM - It Cannot Be Edited

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:RICHARDSON, KENDRAFACILITY NUMBER:
434414311
ADMINISTRATOR:RICHARDSON, KENDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 612-8328
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:14CENSUS: 4DATE:
04/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Kendra RichardsonTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Licensee and explained the reason for the inspection. Present during today's inspection were Licensee, her spouse, and four children, whom 1 was infant. Two of the children were her own.

License, facility sketch, notification of parent's rights, and emergency disaster plan were posted. The hours of operation are Monday through Thursday 7:30AM to 6PM and Friday from 7:30AM to 1PM. There is working phone in home.

LPA toured in the inside and the outside of the home. The off-limit areas of the home are living room, dining room, the entire upstairs, garage, and the right side of the home. There are stairs and a fireplace in the home, which are barricaded. Disinfectant, cleaning supplies, and other items that are dangerous that are were inaccessible to children. Toys and equipment were observed to be good condition. There is a fire extinguisher, smoke detector, and carbon monoxide detector. Licensee stated that there are no weapons, such as firearms, in the home.

The backyard is used and fenced. There are toys and play equipment were in good condition. LPA reminded Licensee to ensure that all gates to off-limit areas are closed. There were no bodies of water observed during today's inspection.

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SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022
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: RICHARDSON, KENDRA
FACILITY NUMBER: 434414311
VISIT DATE: 04/27/2022
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-------------------------continuation of 809 dated 04/27/2022 page 1--------------------------------

The infant in care is Licensee's own child. There is a play yard. LPA observed that there was a mobile hanging in the home. LPA reminded Licensee that nothing should be hanging from the play yard. LPA also reminded Licensee about documenting that she is checking infants every 15 minutes. 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-and-resources/safe-sleep as an additional resource. 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.

Licensee does not provided Incidental Medical Services (IMS). 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: http://www.ada.gov/childqanda.htm



Licensee does not transport children, but understands that children cannot be left alone and unattended in parked vehicles. All meals and snacks are brought from home. The snacks and meals are in children's individual lunch box.

A copy of a facility roster was obtained. 4 children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and notification of parent's rights.


----------------------continues on 809 dated 04/27/2022 page 3--------------------------------------
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: RICHARDSON, KENDRA
FACILITY NUMBER: 434414311
VISIT DATE: 04/27/2022
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Licensee and her spouse's file were also reviewed. Licensee and her spouse have a valid CPR/1st Aid. Licensee's CPR/1st Aid expires on 10/29/2022 and her spouse's expires on 01/30/2023. Licensee and her spouse both completed the Mandated Reporter training. Licensee completed the Mandated Reporter training on 05/23/2021 and her spouse completed it on 05/25/2021. Licensee and her spouse have immunization records for measles and pertussis on file.

The adults 18 and over living in the home are Licensee and her spouse. Licensee has three minor children. All adults have cleared fingerprints and TB clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

As a result of this inspection, two technical violations were issued. Exit interview conducted and report was reviewed with the licensee Kendra Richardson. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
LIC809 (FAS) - (06/04)
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