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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
434416146
Report Date:
11/30/2021
Date Signed:
12/03/2021 04:13:34 PM
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, TAWN
FACILITY NUMBER:
434416146
ADMINISTRATOR:
TAWN COLEMAN
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(408) 420-1984
CITY:
SAN JOSE
STATE:
CA
ZIP CODE:
95123
CAPACITY:
14
CENSUS:
10
DATE:
11/30/2021
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
03:26 PM
MET WITH:
Tawn Coleman
TIME COMPLETED:
03:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Plan of Correction (POC) inspection. LPA met with Licensee Tawn Coleman and explained the reason for the inspection. Licensee was cited on 11/16/2021 for staffing ratio and capacity.
Present during today's inspection were Licensee and 10 children. Her 11 year old child and her 17 year old child was also present. Licensee stated that her 17 year old is helping her with the daycare children. Facility was within ratio and capacity during today's inspection.
Licensee submitted written plan on how she comply with ratio and her capacity.
LPA obtained a copy of her facility roster during today's inspection. LPA provided her a copy of ratio and capacity during today's inspection.
No deficiencies were cited as result of this inspection. Exit interview conducted and report was reviewed with Licensee Tawn Coleman. A notice of site visit was given and must remain posted for 30 days; along with a copy of this report.
SUPERVISOR'S NAME:
Joel Segura
TELEPHONE:
(408) 334-8550
LICENSING EVALUATOR NAME:
Samantha Yip
TELEPHONE:
(408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE:
11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/30/2021
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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