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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413069
Report Date: 02/12/2020
Date Signed: 02/12/2020 03:35:23 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:TAYLOR, MARIEFACILITY NUMBER:
444413069
ADMINISTRATOR:TAYLOR, MARIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 325-5273
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:12CENSUS: 10DATE:
02/12/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Marie TaylorTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analysts Mahvash Behbood, conducted an unannounced random visit. Kit #2 was used for today's inspection. LPA met with Taylor, Licensee, purpose of the visit was explained. Present also were 10 day care children, 3 infant, 4 school age, and 3 pre-schooler. Days and hours of operation are M-- F from 6:00 AM to 6:00 PM. The Licensee and her mother are the only adults that resides in the home.
LPA toured the indoor and outdoor areas of the home. Current Child Care Facility Roster was reviewed. LPA reviewed a current Fire/Disaster drill log. Though licensee has land line her cell l phone is listed as her facility phone. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA did observed a wall heater that is properly barricaded. Off limit areas inside the home:. Spare bedroom. Off limit areas outside the home: the back yard. There are no stairs in the home.
LPA observed a fully charged right size fire extinguisher, working smoke detector, front yard that is used as play area. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, poisons and other similar items are stored inaccessible to children.
CPR and First Aid is current and expires in 2021.

See next page for citations under Title 22.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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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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: TAYLOR, MARIE
FACILITY NUMBER: 444413069
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2020
Section Cited

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Child's Records - Licensee to maintain children's file. This requirement is not met evidence by: Paper work for children were in piles of paper unorganized. This is potentially dangerous to health and safety of children,
Type B
02/28/2020
Section Cited

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IMMUNIZATION SB792-
Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Two staff do not have proof of pertussis, measles and influenza .This requirment is no met evidence by: niether licensee not her helper have proof of immunizaiton against Measles and Pertusis. this is potentially dangerous to health and safety to children
Type B
02/28/2020
Section Cited

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Mandated Child Abuse Reporter- All staff must complete the above training. This requirement is not met evidence by: Licesee traiing expired on 01/20 and her helper has not completed the training, This is potentially dangerous to health and safety of cilldren.

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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2020
LIC809 (FAS) - (06/04)
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