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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414368
Report Date: 12/06/2021
Date Signed: 12/14/2021 03:32:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HARP, CAROLYN CAOAGDANFACILITY NUMBER:
434414368
ADMINISTRATOR:HARP, CAROLYN CAOAGDANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 693-6431
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:14CENSUS: 5DATE:
12/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:58 PM
MET WITH:Carolyn Caoagdan HarpTIME COMPLETED:
04:15 PM
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On Monday 12/06/2021 at 2 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required One (1) Visit. LPA met with Licensee Carolyn Harp and explained the purpose of today’s inspection. Present on this visit were Licensee's son and 5 preschool children in care. The home’s operating days and hours are Monday through Friday 7:00 AM to 6:00 PM.

LPA toured the facility to conduct a Health and Safety Inspection with the Licensee. Facility’s License and Notification of Parents’ Rights were observed to be posted and LPA discussed with Licensee about the personal rights of children in care. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. The On Limit Areas are the Library Room and the Day Care Room - also use for Napping, Hallway Bathroom and the Backyard. The BACKYARD play area is completely fenced. The Off Limit areas are the Kitchen, Dining Room, Living Room, all the three (3) Bedrooms and the Garage which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision. There is a gate located at the entry way of the Living Room. The designated isolation area for a child who becomes ill while in care is the living room. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. Furniture is being used to block the fireplace.
The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. The fireplace is being blocked by furniture to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on October 2021.

Licensee does not own the premises and maintain signed the forms LIC 282, LIC 9149 and LIC 9151 in the facility file.


SEE 809 C.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HARP, CAROLYN CAOAGDAN
FACILITY NUMBER: 434414368
VISIT DATE: 12/06/2021
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Continuation...........

At 2:15 pm, LPA observed a Pet/Service Dog that are kept in one of the bedrooms and not allowed when Children are in care. LPA reviewed the vaccination of the Pet/Service Dog.

The Licensee stated that she does not transport children at this time but understands that children cannot be left alone, unattended in parked vehicles at any time.

Facility's roster of children who are provided care was reviewed and a copy was obtained. Children’s files were reviewed, which included records of Identification and Emergency Information and Immunization. The licensee is in ratio today.

The licensee CPR and First Aid certificate and expires on 07/2022. The licensee completed the Mandated Reporter General Training and Child Care Providers training online at https://mandatedreporterca.com/ on 09/27/2021. Licensees have records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SEE 809 C.....

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
LIC809 (FAS) - (06/04)
Page: 3 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HARP, CAROLYN CAOAGDAN
FACILITY NUMBER: 434414368
VISIT DATE: 12/06/2021
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LPA discussed the following;
1. Contact Information of Santa Clara County Office of Education Childcare Resource & Referral Program Phone: 669-212-KIDS (5437), mail: childcarescc@sccoe.org and https://www.childcarescc.org/child-care-application
2. For questions about registration or your stipend, please call 1-833-398-1399. Hours of operation are 6:00am – 6:00pm CST, email - ARPASurvey@cde.ca.gov
https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/licensed-stipends
3. If you would like to report an Unusual Incident, please call our Main Office (510) 622 – 2602, there would be two (2) Desk Duty Analyst that are available to assist you.
4. If you have questions regarding a communication you received from CPMB, please visit the Frequently Asked Questions page or contact CPMB at 1-888-422-5669 or Guardian@dss.ca.gov

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.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [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.

There are no deficiencies cited on this 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 Carolyn Caoagdan Harp.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021
LIC809 (FAS) - (06/04)
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