434416146-9-22-2022-07-CC-JCRZ-CJHQ8Z-20220922115734

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416146
Report Date: 09/22/2022
Date Signed: 09/22/2022 11:57:49 AM

Document Has Been Signed on 09/22/2022 11:57 AM - 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, 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	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	09/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:28 AM
MET WITH:	Tawn Coleman		TIME COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Janette Cruz met with Tawn Coleman, Licensee, for an unannounced Required – 1 year annual inspection. LPA was granted access to the home by Licensee's assistant, Christina Powell. LPA also observed seven children in care with Licensee's other assistant, Rose Telles, present in the home during today's inspection. LPA observed the required postings, including the facility license, near the front entrance of the home. Days and hours of operation are Monday - Friday from 7:30AM to 5:00 PM. The Licensee states her father- Frederick Coleman, her adult daughter- Destiny Mosbrucker , her adult son, Anthony Woodruff and roommate- Angela Alcobendas are the adults living in the home. Licensee also has her minor children (daughter- 12 y/o and two sons- 10 and 8 y/o) and her grandson (3 y/o) living in the home. Licensee has clearances for Tuberculosis and Criminal Background/Child Abuse Index clearances. Licensee has current CPR and First Aid certifications (expiration: 06/2023). Licensee has the required vaccinations (MMR, Tdap, & flu) and is current with the Mandated Reporter Training for Child Care Workers (expiration: 06/22/2023). There are no active waivers for this facility. LPA reviewed a Fire/Disaster drill and Child Care Roster log during today's inspection. The last fire/disaster drill was completed on 07/01/22. Licensee does not carry an active Child Care Liability Insurance. LPA discussed the safe sleep regulations with the Licensee 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 the Licensee 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.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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 4

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: COLEMAN, TAWN	FACILITY NUMBER: 434416146
	VISIT DATE: 09/22/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA toured the indoor and outdoor areas of the two-story home during today's inspection. Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. Licensee states that a child will be isolated in the kitchen area of the home if necessary due to illness or communicable disease

LPA observed the home is clean, orderly, and safe for the day care children. LPA observed a barricaded fireplace and no open face heater units. The Licensee has the living room, and playroom primarily used for the day care. Off limit areas inside the home: first floor- master bedroom, additional bedroom, garage, entire second floor (3 bedrooms, 1 bathroom). Off limit areas outside the home: dog run.

LPA observed a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detectors, LPA also observed no bodies of water, and a fenced backyard. The Licensee states that she does not have any weapons in the home. LPA observed that Licensee has several pets including 3 large dogs- (Dogo Argentino Breed/ German Shepherd lab mix breed), 3 cats , 2 snakes, 2 bearded dragons (in covered, locked aquariums) and 2 rats (off limit area). Licensee stated that the pets are kept away from children except for the cats that can freely roam.

All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are stored in high cabinets and upper shelves. The Licensee states that she does not administer medication to the day care children.

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

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

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: COLEMAN, TAWN	FACILITY NUMBER: 434416146
	VISIT DATE: 09/22/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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.

Supervision of children was discussed with Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options that she cannot have more than 14 children in the home at any time.

Licensee states that she does not transport day care children. The Licensee understands that children shall not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.

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.

Exit interview conducted and report was reviewed with the Licensee, Tawn Coleman

A deficiency and a technical violation was issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 09/22/2022 11:57 AM - It Cannot Be Edited

Created By: Janette Cruz On 09/22/2022 at 10:57 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: COLEMAN, TAWN	FACILITY NUMBER: 434416146
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102369(9)

102369 Application for Initial License (9) Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above. Licensee did not obtain a current tuberculosis clearance for adult assistant #3 which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/13/2022
	Plan of Correction
1 2 3 4	Licensee will submit to the Department a current tuberculosis clearance for adult assistant #3

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Diana Stephenson

LICENSING EVALUATOR NAME:

Janette Cruz

LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4