430755192-1-8-2025-52-CC-JZHU-DCQRH6-20250108120150

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430755192
Report Date: 01/08/2025
Date Signed: 01/08/2025 01:11:50 PM

Document Has Been Signed on 01/08/2025 01:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	TZUGARIS, CHRYSTIE & FELSCH, SHAWN		FACILITY NUMBER:	430755192
ADMINISTRATOR/ DIRECTOR:	CHRYSTIE & SHAWN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(650) 493-0665
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	01/08/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Chrystie Tzugaris & Shawn Felsch		TIME VISIT/ INSPECTION COMPLETED:	12:20 PM

NARRATIVE

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On 01/08/2025 at 9:30am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with licensees Chrystie Tzugaris and Shawn Felsch for an unannounced annual inspection. Upon arrival, LPA provided licensee a copy of the Entrance Checklist (LIC 126). The facility is a two-story home. Also residing in the home is Shawn’s spouse. The home was toured to conduct a Health and Safety Inspection in the on-limits areas only. The facility’s current hours of operation are Monday - Friday from 8:00am - 5:30pm.

Ratio/Capacity: The facility operates as a large Family Child Care Home licensed with a capacity of 14 children. At the time of the inspection, there were five (5) children in care. The licensee is within ratio and in compliance with capacity regulations today.

On-limit Areas (accessible by children in care): The on-limit areas are the main classroom (converted from garage), kitchen, living room, dining room, office (next to kitchen), two first floor bathrooms, bedroom by the entrance and both side yards. The primary areas used for the day care are the main classroom and both side yards. The isolation area is a section of the main classroom. When a child shows signs of illness, he/she will be separated from other children here. The inside of the home is observed to be clean and orderly, with central heating and ventilation for safety and comfort. LPA observed there are ample safe and age-appropriate toys, play equipment and materials. All toxins, cleaning products, and hazardous materials have been made inaccessible to the children.

The outdoor play area is one of the side yards, which is completely fenced with visual supervision. The outdoor play area is free from defects or dangerous conditions. There is an ample supply of age-appropriate toys and activities available for children, and they are in good condition. There is ample shade available, and gates are locked at all times while children are in the backyard. There is a small play structure equipped with a swing and slide. The ground around the play structure is properly padded with mulch. There are no pools, hot tubs, or similar bodies of water on premises.

Page 1 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 8

Document Has Been Signed on 01/08/2025 01:11 PM - It Cannot Be Edited

Created By: Jialing Zhu On 01/08/2025 at 11:05 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TZUGARIS, CHRYSTIE & FELSCH, SHAWN	FACILITY NUMBER: 430755192
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2025

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 licensee interview and record review, the licensee did not comply with the section cited above as both licensees's most current Mandated Reporter Certificate expired on 10/02/2023, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/07/2025
	Plan of Correction
1 2 3 4	Licensees will complete the Mandated Reporter Training for Child Care Providers and email the certificates to LPA at jialing.zhu@dss.ca.gov by 02/07/2025.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as both licensees' most current Pediatric CPR/First Aid certificates are expired (expiration dates: 09/17/2023 and 02/19/2024), which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/20/2025
	Plan of Correction
1 2 3 4	Licensees will register for a Pediatric CPR/First Aid class by 01/20/2025. Licensee will email proof of registration to LPA at jialing.zhu@dss.ca.gov by 01/20/2025. Licensees is will also email certificates once they complete the training.

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:

Chandra Charles

LICENSING EVALUATOR NAME:

Jialing Zhu

LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

Page: 2 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TZUGARIS, CHRYSTIE & FELSCH, SHAWN	FACILITY NUMBER: 430755192
	VISIT DATE: 01/08/2025

NARRATIVE

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Off-limit Areas (not accessible by children in care): The off-limit areas are the one of the first floor bedrooms, entire second floor, front yard, and small gated yard in the rear, which are inaccessible by closed and/or locked doors and visual supervision. Stairs in the home are properly fenced and barricaded with a baby gate, which makes the second floor inaccessible to children in care. The front yard is used as a walkthrough to enter the on-limit areas. When children are in the front yard, they must be accompanied by parents. LPA advised licensee she must contact Licensing for an inspection prior to changing an OFF-Limit area to ON-Limit.

Child Care Operations: Licensee provides AM/PM snacks and meals for the children. LPA observed sleep cots are used for napping. Children bring their own bedding, which are stored and washed at the facility. All food and bedding brought from children’s home are labeled with the children’s name and stored appropriately.

Emergency Preparedness/Safety: A fully charged 3A40BC fire extinguisher is located in the main classroom. LPA observed at least one functional combination smoke and carbon monoxide detector in the main classroom. Fire/disaster drills are conducted at least once every six months, and the last drill was on 10/24/2024. The home is equipped with telephone service and first aid supplies. Per licensee, there are no firearms in the home. There are two pets in the home.

Recordkeeping Review: All adults living in the home have obtained a criminal record clearance. The licensee is in compliance with the immunization laws. Both licensees' most current Pediatric CPR/First Aid certificates are expired (expiration dates: 09/17/2023 and 02/19/2024). Both licensees's most current Mandated Reporter Certificate expired on 10/02/2023.

A current facility roster is available for review. LPA reviewed five (5) children’s files. Licensees owns the property. Per licensee, the facility has liability insurance. All required Licensing documents are posted in the hallway by the main classroom.

Licensee was reminded that California Law requires licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Incidents must be reported within 24 hours by phone, fax, or email. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov.

Page 2 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

Page: 6 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TZUGARIS, CHRYSTIE & FELSCH, SHAWN	FACILITY NUMBER: 430755192
	VISIT DATE: 01/08/2025

NARRATIVE

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Licensee was also reminded that Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed of the MyChildCarePlan.org site, 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.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Page 3 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

Page: 7 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TZUGARIS, CHRYSTIE & FELSCH, SHAWN	FACILITY NUMBER: 430755192
	VISIT DATE: 01/08/2025

NARRATIVE

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Two (2) Type B deficiencies and three (3) Advisory Notes were issued during today’s inspection.

Type B Deficiencies:

1. Both licensees do not have current Pediatric CPR/First Aid certification

2. Both licensees do not have current Mandated Reporter training certification.

Advisory Notes (Technical Violations):

1. 2 of 5 children’s files do not have up-to-date immunization records.

2. 2 of 5 children’s files do not have signed copies of LIC 995A Notification of Parent Consent.

3. 3 of 5 children’s files do not have signed copies of LIC 627 Consent for Emergency Medical Treatment.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted, report was reviewed, and Appeal Rights were provided to licensee Shawn Felsch.

Page 4 of 4. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

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