430756823-10-9-2023-07-CC-JBOT-CWFUL5-20231009154010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430756823
Report Date: 10/09/2023
Date Signed: 10/09/2023 03:40:15 PM

Document Has Been Signed on 10/09/2023 03:40 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SMITH, NIKI & CLAUDE		FACILITY NUMBER:	430756823
ADMINISTRATOR:	SMITH, NIKI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 289-8278
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Niki Smith & Claude Smith		TIME COMPLETED:	04:00 PM

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Licensing Program Analysts (LPAs) Jessica Bongardt and Mel Matos met with Niki and Claude Smith, Licensees, for an unannounced Required – 1 year annual inspection. LPAs were granted access to the home by the Licensees. The Facility was closed for the day; however, both agreed to proceed with today's inspection. The main indoor area of the day care is located in the converted/permitted detached garage (Playroom) and the front home is entirely off limits. LPAs observed the required postings, including the facility license, near the front entrance to the day care. Days and hours of operation are Monday through Friday 7:30AM to 5:30PM. Both Licensees are the only adults residing in the home. Licensees state that there are no minor children residing in the home.

LPAs reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on 08/21/2023. Licensees state that they do not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) to all enrolled families. Licensees have current CPR and First Aid certifications (expiration: 04/2024). Licensees have the required vaccines (MMR, Tdap, & flu) and are current with their Mandated Reporter Training for Child Care Workers (expiration: 03/06/2024. LPAs reviewed 4 children's files and the files were complete with the required forms. LPAs reviewed 2 staff files (Licensees) and the files were complete with the required forms. Licensees state that a child will be isolated sleeping part of the facility if necessary due to illness or communicable disease.

LPAs toured the indoor and outdoor areas of the facility during today's inspection. Licensees have a working telephone in the facility. The facility 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 facility. There are no stairs or wall heaters inside the facility. The day care is located in the converted/permitted detached garage (Playroom) which also has a bathroom for the children. The off limits area of the day care: entire front home (living room, family room, dining room, kitchen, two bathrooms and three bedrooms). Off limit area outside the home: locked storage area.

LPAs observed a fully charged 3-A-40-BC fire extinguisher, working smoke/carbon monoxide detectors, no bodies of water, and fenced backyard. The Licensee states that she does not have any weapons in the facility. Licensees have 2 dogs in the home that are vaccinated. LPAs reminded the Licensees that pet food and water must be inaccessible whenever day care children are present. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. All poisons are stored in the locked storage shed, located in the backyard.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

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: SMITH, NIKI & CLAUDE	FACILITY NUMBER: 430756823
	VISIT DATE: 10/09/2023

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Licensees state that they do not administer any medications to the day care children. Licensees state that they provide snacks to the day care children. Licensees state that parents bring lunches for the children. Licensees understand that any food brought from home shall be labeled with each child's name and properly stored. Licensees have a first aid kit in the home which includes a touch less thermometer. Licensees state that nobody smokes and Licensees understand that smoking is prohibited in the home.

Supervision of children was discussed with the Licensees and they understand that they must be present in the home during day care hours and ensure that the children are supervised at all times. Licensees understand their capacity/ratio options and they understand that they cannot have more than 14 children present in the home without two qualified adults present. Licensees state that they do not transport any day care children. Licensees understand 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.

Niki Smith and Claude Smith, Licensees, were 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 per person will be assessed if this regulation is violated.

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/.

LPAs discussed the safe sleep regulations with Licensees and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs also informed Licensees 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.Licensees were 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 Licensees, Niki Smith & Claude Smith. No deficiencies issued during today's inspection.

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

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

LIC809 (FAS) - (06/04)

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