434416177-2-7-2025-07-CC-SYUU-DDNPCB-20250207101141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416177
Report Date: 02/06/2025
Date Signed: 02/07/2025 10:12:12 AM

Document Has Been Signed on 02/07/2025 10:12 AM - 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:	HARRIS, LAKISHA		FACILITY NUMBER:	434416177
ADMINISTRATOR/ DIRECTOR:	LAKISHA HARRIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 300-0419
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 4	DATE:	02/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:37 AM
MET WITH:	Lakisha Harris		TIME VISIT/ INSPECTION COMPLETED:	11:25 AM

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Licensing Program Analyst (LPA), Shine Yu, conducted an unannounced Annual Inspection 08:37 am and was greeted and met with the Licensee, Lakisha Harris .

Present are licensee and 4 children, including 2 under 2 years old.

LPA observed the following materials posted on the bulletin board, including the Facility License, Emergency Disaster Plan (LIC 610), Notification of Parents' Rights (PUB 393). LPA observed fire and disaster drill log, the last time was conducted on 1/13/2025. Facility's operating hours are Monday to Friday 7:30 AM to 5:30 PM. All the children enrolled now are full time. LPA observed and obtained a copy of current Children's roster from licensee. LPA observed the sleep log is current and up to date.

Licensee accompanied with LPA toured the facility. The bathroom is organized and clean. LPA observed bathroom items, soap and shampoo bottles on higher place where inaccessible by children. Licensee stated there is no firearm in the facility. Licensee provides breakfast, lunch and snacks for children in care. LPA observed the smoke detector and carbon monoxide in the living room and garage. LPA observed fire extinguisher with receipt 11/03/2024 in the kitchen area. The outdoor play area is enclosed with appropriate fence and safe for children. There is no body of water observed outside of play area. There are plenty of age appropriate toys in activity room and garage area.

LPA reviewed a random selection of children's file and observed that notification of parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file.

The licensee's Pediatric First Aid & CPR ( renew by July, 2025) and Mandated Reporter are current, expires on 6/21/2025.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

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: HARRIS, LAKISHA	FACILITY NUMBER: 434416177
	VISIT DATE: 02/06/2025

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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 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-andresources/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 stated there is no medication provided in the facility. 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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

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: HARRIS, LAKISHA	FACILITY NUMBER: 434416177
	VISIT DATE: 02/06/2025

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with the licensee Lakisha Harris.

the licensee also confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Syhshyan Yu
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

LIC809 (FAS) - (06/04)

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