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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415831
Report Date: 12/04/2019
Date Signed: 12/04/2019 11:05:12 AM

COMPREHENSIVE INSPECTION
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:SALSBURY, VANESSAFACILITY NUMBER:
434415831
ADMINISTRATOR:SALSBURY, VANESSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 685-2310
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 8DATE:
12/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Vanessa SalsburyTIME COMPLETED:
11:10 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Annual Inspection of the Family Day Care home. LPA met with Licensee Vanessa Salsbury and explained to her the purpose of the inspection. Present were eight children in care, of whom three were infant age. Licensee and two Assistant Providers Sharon Johnson and Cris Gonzales were present providing care and supervision to the children.

The home’s operating days and hours are Monday through Friday from 07:30 AM to 06:00 PM. The home maintains telephone service. The License and Notification of Parents’ Rights were observed to be posted. The home was inspected inside and out. LPA did not observe flies, other insects, or rodents during the inspection. The observed children’s toys, play equipment, and furniture were in good condition. There were no baby walkers at the day care. Bathroom used by children was observed to be clean and in operating condition. There were two pet cats in the home. Detergents, cleaning compounds, sharps, medicines, and other items which could pose a danger if readily available to children were stored inaccessible.

The Garage is the Master Bathroom are the only two areas that are Off Limit to the children. Backyard is fenced and is used for outdoor activity. There were no bodies of water observed. Licensee stated that there were no weapons stored on the premises. A fully charged fire extinguisher last serviced on 09/2019 was observed. Carbon monoxide and Smoke Detectors were tested and proved to be functioning. Record shows that the last fire and disaster drills were conducted on 06/03/19. Licensee stated that she does provide transportation to the children. Licensee has a current and valid driver license. LPA reminded Licensee that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

Children’s files were reviewed, which included records of Identification and Emergency Information, Consent for Emergency Medical Treatment, Receipt for Parents' Rights Notice, and immunization.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SALSBURY, VANESSA
FACILITY NUMBER: 434415831
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2020
Section Cited

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HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against [...], pertussis, and measles. [...] The family day care home shall maintain documentation of the required immunizations.
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This requirement is not met as evidenced by:
Per LPA's review of files, Licensee failed to maintain documented proof of Assistant Provider Sharon Johnson's immunity against Measles. This poses a potential risk to the health and safety of children in care
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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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2019
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SALSBURY, VANESSA
FACILITY NUMBER: 434415831
VISIT DATE: 12/04/2019
NARRATIVE
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Facility's Children roster was reviewed and a copy was obtained. Licensee and Assistant Providers Sharon Johnson and Cris Gonzales' files were reviewed, which included record for Criminal and Child Abuse Background Check Clearance, immunization, Tuberculosis Clearance, and required Training etc. Licensee's Pediatric CPR/1st Aid Certificate expires on 03/10/2020 and her AB1207 Mandated Reporter Training Certificate expires on 10/19/2020.

Licensee stated that she is the only adult residing in the home. She has Clearances for TB, and Criminal Background and Child Abuse Index Checks. LPA reminded Licensee 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc. Beginning January 1, 2019 AB2370 requires licensed homes to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA reviewed and provided a copy of the “Lead Poisoning Facts Information Flyer." Safe sleep information was also provided to Licensee.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm> .

In the areas that were evaluated, one regulatory violation was observed at the time of the inspection.
Exit interview was conducted, where this report, the violation, plan of correction, and appeal rights were reviewed with Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
LIC809 (FAS) - (06/04)
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