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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413314
Report Date: 06/12/2019
Date Signed: 06/12/2019 02:35:58 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:MAGUIRE, TERESAFACILITY NUMBER:
444413314
ADMINISTRATOR:MAGUIRE, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 247-8925
CITY:CAPITOLASTATE: CAZIP CODE:
95010
CAPACITY:14CENSUS: 9DATE:
06/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Teresa MaguireTIME COMPLETED:
02:45 PM
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Unannounced random visit made by Analyst Mahvash Behbood. Licensee and her assistant were present, most of the 9 children present were napping, 2 children were infant and the rest were preschooler.
Effect of lead exposure poster was provided to licensee and she agreed to share the information with parents.
There are no bodies of water in the yard.
Teresa states there are no weapons in the home.
Cleaning supplies are stored in the garage. The kitchen drawer with sharp knives has magnet locks. Medicines and cleaning supplies are stored up high in the bathroom.
Fireplace has a screen.
Fire extinguisher is the correct size. Smoke and carbon monoxide detectors work.
Home is clean and Teresa states her heater is working. CCL has cell number on record she also has land line.
Children were supervised during the visit.
Discussed with Teresa was safe sleep for children under 1.
Backyard is fenced. Teresa states the day care children do not jump on the trampoline.
Teresa has children's roster.
Fire/disaster drills are written down.
Teresa and her husband Kevin are the adults who live in the home. They have 2 children, 11 and 6 years old. All adult living in the home and her staff have criminal record clearance.
Teresa and her assistance have current pediatric 1st aid/CPR. They both have copies of their immunization record. They also completed the Mandated Child Abuse Reported Training.
Off limits: Garage, and one side yard,
No deficiency cited today.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
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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