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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415854
Report Date: 03/15/2021
Date Signed: 03/15/2021 02:25:00 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:GOLDMAN LISAFACILITY NUMBER:
444415854
ADMINISTRATOR:GOLDMAN LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 427-1159
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:14CENSUS: 7DATE:
03/15/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lisa GoldmanTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Goodell met with licensee Lisa Goldman, via Teams Meeting due to COVID-19 restrictions. On 2/28/21, Licensee submitted a request for studio to be used for child care. LPA obtained updated fire clearance on 3/8/21. LPA observed 7 children present with two staff and licensing in the outdoor area. All individuals subject to criminal background review have obtained a criminal record clearance. Hours of operation are Monday-Friday, 8:30am-5pm.

During inspection LPA observed all as accessible to children including studio and bathroom located in outdoor area. LPA observed dual smoke and carbon monoxide detector and fire extinguisher 3A40BC located in studio. LPA also observed required licensing documents posted at entrance of studio. Licensee acknowledged studio and bathroom located in yard are additional space for childcare due to family day care homes for children should be situated in normal residential surroundings so as to give children the home environment which is conducive to healthy and safe development. In addition, it is the public policy of this state to provide children in a family day care home the same home environment as provided in a traditional home setting. Off limit areas include master bedroom, guest bedroom, kitchen, living room and garage.

No Title 22 deficiencies 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: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021
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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