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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416506
Report Date: 04/28/2022
Date Signed: 04/28/2022 03:49:03 PM

Document Has Been Signed on 04/28/2022 03:49 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BERKMAN, MICHELLEFACILITY NUMBER:
434416506
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Michelle BerkmanTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Applicant, Michelle Berkman, for an announced prelicensing inspection at 529 Anacapa Ter, Sunnyvale, CA 94085. Applicant's spouse, James Berkman, was also present during today's inspection. The adults that reside in the home are the Applicant and her spouse. There are no minor children residing in the home.

Days and hours of operation will be Monday - Friday from 8:30 AM to 5:00 PM. Applicant completed her Preventative Health and Safety Child Care Training on May 28, 2021 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on June 12, 2023. Applicant completed the Mandated Reporter Training for Child Care Workers on 02/28/2022 and a copy is on file. A copy of current TB test results are on file for the Applicant and her spouse. Copies of current Mmr, Tdap, and flu immunizations are also on file for the Applicant. Applicant and her spouse rent the home and copies of the Owner/Landlord Notification (LIC 9151) and valid lease agreement verifying control of property are on file. Applicant understands that she cannot care for more than six children at any one time unless she obtains owner/landlord consent and submits a signed Owner/Landlord Consent form (LIC 9149). Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (FCCH).

LPA toured the indoor and outdoor areas during today's inspection. LPA notes that the home is two story and the downstairs area of the home will be used for the day care. There are no wall heater units in the home. Off limit area inside the home (1st floor): 2 locked doors, 2 locked cabinet doors (under kitchen sink), attached garage, & laundry room. Off limit areas inside the home (2nd floor): primary bedroom, office #1 & #2, sitting room, and two bathrooms. There are stairs inside the home that are properly barricaded.

The home is clean and orderly, with heating/air conditioning, and ventilation for safety & comfort. There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors. LPA observed a fully charged fire extinguisher (2A10BC), working combo smoke and carbon monoxide detectors, fenced backyard, and no bodies of water. Applicant states that she does not have any weapons in the home. Applicant states that she has two cats in the home and she understands that any pet food/treats/litter boxes must be inaccessible to children.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BERKMAN, MICHELLE
FACILITY NUMBER: 434416506
VISIT DATE: 04/28/2022
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Forms of discipline used by Applicant: talking to children/redirection. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. Applicant states that there are no poisons in the home. LPA reminded Applicant that smoking, baby walkers, and similar items are not allowed in Family Child Care Homes.

Applicant understands that children's personal rights should not be violated; including no corporal punishment. isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPA informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

Michelle Berkman, Applicant, 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the requirements of AB 633 with the Applicant. Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

LPA provided and reviewed the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

LPA provided and discussed the safe sleep regulations with Applicant 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 Ruma 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
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BERKMAN, MICHELLE
FACILITY NUMBER: 434416506
VISIT DATE: 04/28/2022
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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:
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: http://www.ada.gov/childqanda.htm

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 platform.

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.

Exit interview conducted and report was reviewed with the Applicant, Michelle Berkman, Applicant, and advised her that the following items need to be completed prior to a small Family Child Care Home license being approved:

1) Air conditioner unit in the backyard has been barricaded.
2) Left side section of the backyard needs to be barricaded.
3) Thorny weeds and overgrown rose bushes have been cut back or removed.
4) Updated Facility sketches have been submitted to LPA

Applicant agreed to submit pictures of items #1-3 and updated sketches to LPA by Friday May 6, 2022.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022
LIC809 (FAS) - (06/04)
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