444415854-2-21-2024-07-CC-JBOT-D29TCE-20240208133637

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444415854
Report Date: 02/08/2024
Date Signed: 02/21/2024 10:12:59 AM

Document Has Been Signed on 02/21/2024 10:12 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/15/2024 10:08 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

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	“This is an amended report. Amendments have been discussed with licensee, Lisa Goldman, and new signatures on amended reports were obtained.” Licensing Program Analyst (LPA) Jessica Bongardt met with Lisa Goldman for an unannounced Required – 3-year annual inspection. LPA was granted access to the home by the Licensee. LPA also observed ten children in the home during today's inspection. Licensee was operating within her capacity and ratio requirements. LPA observed the required postings, including the facility license, near the front entrance to the home. Days and hours of operation are Monday to Friday 8:30 AM to 4:00PM. There are two adults residing in the home the Licensee and her Partner who is fingerprinted and TB tested. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 01/06/2024. Licensees state that they do have liability insurance for the day care. Licensee have current CPR and First Aid certifications (expiration 10/10/2024). Licensee have the required vaccines (MMR, Tdap, & flu opt out) and are is not current with her Mandated Reporter Training for Child Care Workers. LPA reviewed four children's files and the files were complete. Licensee states that a child will be isolated from the other children in the napping room of the day-care if necessary due to illness or communicable disease until a parent/guardian is able to pick them up. LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (831) 427-1159. The home is clean, orderly, (including heating/air conditioning/ventilation), and safe for the day care children. There are safe & age appropriate toys, play equipment, and materials for the children in the home. There are stairs outside the home they are blocked off so the children can not get to them. LPA did not observe any wall heaters inside the home.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GOLDMAN LISA	FACILITY NUMBER: 444415854
	VISIT DATE: 02/08/2024

NARRATIVE

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LPA observed a fully charged (3A40BC) fire extinguisher, working smoke/carbon monoxide detectors, and fenced backyard. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

Licensee states that she does not administer any medications to the day care children. Licensee states that she does not provides meals to the day care children. All meals are brought from home. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored. Licensee has a first aid kit in the home which includes a touch-less thermometer. Licensee states that nobody smokes, and she understands that smoking is prohibited in the home.

The licensee understands that children's personal rights should not be violated, including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threats, mental abuse, or other actions of a punitive nature.

Supervision of children was discussed with the 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. Licensee understands her capacity/ratio options and she understands that she cannot have more than 14 children present in the home. Licensee states that she does not transport any day care children. 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days/$3000.00 per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GOLDMAN LISA	FACILITY NUMBER: 444415854
	VISIT DATE: 02/08/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

The licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Exit interview conducted and report was reviewed with the Licensee, Lisa Goldman .One deficiency were issued during today's inspection.

A notice of site visit was given and must remain posted for 30 day

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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Document is an Amendment of Original Document on 02/15/2024 10:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GOLDMAN LISA	FACILITY NUMBER: 444415854
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. 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 in which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/16/2024
	Plan of Correction
1 2 3 4	Licensee will complete Mandated Reporter training by the Plan of Correction date and email a copy of the certificate to LPA.

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	No violation of this section was observed; no deficiency cited
	POC Due Date: 02/16/2024
	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: Gladys Kuizon	TELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica Bongardt	TELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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