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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416146
Report Date: 03/15/2022
Date Signed: 03/15/2022 03:42:03 PM


Document Has Been Signed on 03/15/2022 03:42 PM - 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:COLEMAN, TAWNFACILITY NUMBER:
434416146
ADMINISTRATOR:TAWN COLEMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 420-1984
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:14CENSUS: 14DATE:
03/15/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Tawn ColemanTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Legal/Non-compliance inspection. LPA met with Licensee Tawn Coleman and explained the reason for the inspection. The purpose of this inspection is Licensee came into the San Jose Regional Office on 12/29/2021 for an informal meeting due to staffing ratio and capacity and caregiver background check.

Upon arrival, LPA observed that there were 15 children, whom 2 were infant age. One of the children was her own child and was under the age of 10. LPA observe that he walked in, then left the home with his dad. LPA discussed with Licensee that her own children who are under 10 years old would count her ratio.

As a result of this inspection, a technical violation was issued. 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. 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: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2022
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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