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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416146
Report Date: 10/25/2021
Date Signed: 10/25/2021 10:46:33 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:COLEMAN, TAWNFACILITY NUMBER:
434416146
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
10/25/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tawn ColemanTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Goodell met with licensee Tawn Coleman for a Case Management inspection for a Capacity Increase follow-up. Licensee submitted application requesting to increase from a small family child care license to a large. LPA obtained proof of fire clearance on 10/8/21 and first inspection was conducted on 10/18/21.

During inspection LPA observed three children present with licensee and assistant. All individuals subject to criminal background review have obtained a criminal record clearance. LPA toured the facility and areas accessible to children. LPA also toured the off limits bedroom located downstairs near kitchen due to bedroom locked during inspection conducted on 10/18/21.

Effective 10/25/21, facility is approved for a large family child care license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021
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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