<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434405907
Report Date: 07/10/2025
Date Signed: 07/10/2025 04:40:08 PM

Document Has Been Signed on 07/10/2025 04:40 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:SPINDOLA, ELIZABETHFACILITY NUMBER:
434405907
ADMINISTRATOR/
DIRECTOR:		SPINDOLA, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 826-2116
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/10/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Veronica Vargas Alvarez and Kyler SpindolaTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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
At 9:05 AM, Licensing Program Analyst (LPAs), Jaime Gonzales and Mandeep Kaur met with staff Veronica Vargas Alvarez for an unannounced Plan of Correction (POC) inspection. The purpose of today's inspection is to follow up on a Plan of corrections(POCs) those were due on 06/26/2025 and 07/07/2025 and were cited on 06/25/2025. Upon arrival present were two (2) staff (S1& S2) with eight children including two(2) infants.

LPAs toured indoor areas of the facility with staff (S1). LPAs reviewed two(2) children (C1&C2) for Immunization Record PM 286 form, LIC 9227( Individual Infant Sleeping Plan), physical 15 minutes check and documentation and two(2) staff (S2&S3) for immunization records during today's inspection.

At 10:03AM, Adult, Kyler Spindola arrived and left the facility at 11:48AM. At 10:40AM, Staff(S3) and another child joined during inspection.

During today's inspection, LPAs interviewed two(2) staff(S1&S3) in person and licensee, Elizabeth Spindola over the phone.

**Continue on next pages**
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Jaime Gonzales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 5
Document Has Been Signed on 07/10/2025 04:40 PM - It Cannot Be Edited


Created By: Jaime Gonzales On 07/10/2025 at 03:05 PM
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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SPINDOLA, ELIZABETH
FACILITY NUMBER: 434405907

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2025
Section Cited
CCR
102417(a)

1
2
3
4
5
6
7
Operation of a Family Child Care Home: (a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
By plan of correction due date, 07/17/2025, Licensee will submit the written statement of understanding of the Title 22 required regulations of Temporary absences for the licensee shall not exceed 20 percent of the hours the facility is providing care per day including the future plan of licensee to be present at the facility for at least 80 percent of the hours of operation per day, to the department.
8
9
10
11
12
13
14
Based on observations and interviews, Licensee was not present on 06/25/2025 during inspection and licensee is not present during today's inspection. Licensee self-admitted that she is going to be at the facility, tomorrow, Friday, 07/11/2025.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Belinda Devall
NAME OF LICENSING PROGRAM MANAGER:
Jaime Gonzales
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
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: SPINDOLA, ELIZABETH
FACILITY NUMBER: 434405907
VISIT DATE: 07/10/2025
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
26
27
28
29
30
31
32
The facility was issued Eight(8) Type B deficiencies per section codes: 102425(a)(3), 102425(b)(3), 102418(g)(1), 102425(c), 102417(g)(4), 102416.2(a)(2) and under Health and safety sections: 1597.543 and 1597.622(a)(1) and two Type A deficiencies were issued per section code; 102425(j) and 102425(j)(2)(D) on June 25, 2025.

During today's inspection, LPAs observed following:
1) Licensee is not present during today's inspection.
2) Facility did not conduct 15 minutes checks for children (C1&C2) on dates: 06/26/2025 and 06/27/2025.
3) Staff did not document 15 minutes checks while the children (C1&C2) were present on 06/26/2025 and 06/27/2025.
4) Adult (A1) is associated to the facility as of July 9, 2025.
5) Carbon monoxide and smoke detectors are operable.
6) Safe sleep sound machine and a balloon have been removed and plastic arch was removed during today's inspection.
7) Missing California Pre-Kindergarten and School Immunization Record PM 286 form for two infants(C1& C2).
8) Missing proof of Immunization (measles, pertussis and tuberculosis test) records for staff(S2).
9)Missing proof of tuberculosis test for staff (S3).
10) Two Play yards do not have tight fitting bedding for the mattress size.
11) Missing Individual Infant Sleeping Plan (LIC 9227) for infants(C1&C2).
12) Lysol wipes were observed under the sink area of the kitchen accessible to the children and 11 knives were observed in one of the top drawers in the kitchen area accessible to the children.

**Continue on next page**
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Jaime Gonzales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: SPINDOLA, ELIZABETH
FACILITY NUMBER: 434405907
VISIT DATE: 07/10/2025
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
26
27
28
29
30
31
32
Based on observations and interviews, Licensee was not present on 06/25/2025 during inspection and licensee is not present during today's inspection. Licensee self-admitted that she is going to be at the facility, tomorrow, on Friday, 07/11/2025.

One Type B deficiency issued during today's inspection on attached 809-D. Appeal rights provided. Total civil penalties of failure to correct in the amount of $1700 is assessed for the deficiencies, those were issued on 06/25/25 and facility has not submitted the plan of correction to the department for those deficiencies.

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

At 10:31AM, report was reviewed with Licensee, Elizabeth Spindola over the phone regarding deficiencies' plan of correction, those were cited on 06/25/2025.



At 03:55PM, Licensee, Elizabeth Spindola authorized Adult, Kyler Spindola to sign the report. At 03:55PM, Exit interview conducted and report was reviewed with licensee, Elizabeth Spindola over the phone. Phone calls were getting disconnected on multiple occasions. At 04:07PM, a Type B deficiency, that is being issued during today's inspection,civil penalties and the total amount of the civil penalties were discussed with Licensee, Elizabeth Spindola over the phone. Report was reviewed and copy is provided to Adult (A1) and Staff, Veronica Vargas Alvarez.
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Jaime Gonzales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5