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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415854
Report Date: 02/26/2021
Date Signed: 02/26/2021 11:13:59 AM

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:GOLDMAN LISAFACILITY NUMBER:
444415854
ADMINISTRATOR:GOLDMAN LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 427-1159
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:14CENSUS: 8DATE:
02/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lisa GoldmanTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Goodell met with licensee, Lisa Goldman via Teams Meeting due to COVID-19 restrictions. LPA and licensee met to inspection areas accessible to children due to licensee submitting updated facility sketch on 2/17/21. LPA obtained a census of eight children with licensee and two assistances in the back yard area. All individuals subject to criminal background review have obtained a criminal record clearance. Hours of operation are Monday- Friday, 8:30am- 5pm.

Inspection was conducted in all areas accessible to children. LPA observed single story home two bedrooms, one bathroom, dining area, kitchen, garage, front yard and backyard. LPA observed studio added in backyard and restroom. Licensee requested studio and restroom area to be on-limits and designated for child care. Licensee acknowledged that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department. City permit has been approved for studio and proof will be submitted to LPA by 3/1/21. LPA observed fire extinguisher 3A40BC located in the studio. LPA also observed smoke and carbon monoxide detector tested. Off-limits areas include: both bedrooms in the home and garage. Second inspection will be schedule prior to studio used for child care.

No Title 22 deficiency cited. Report was reviewed and discussed. Due to COVID-19 closures, report and Notice of Site Visit were emailed with read receipt request. Report must be returned to LPA with licensee signature.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal GoodellTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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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