434416556-9-15-2023-07-CC-JCRZ-CVPTND-20230915145233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416556
Report Date: 09/15/2023
Date Signed: 09/15/2023 02:52:43 PM

Document Has Been Signed on 09/15/2023 02:52 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:	SALSBURY, VANESSA		FACILITY NUMBER:	434416556
ADMINISTRATOR:	VANESSA SALSBURY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 597-3012
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY:	14	CENSUS: 0	DATE:	09/15/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Vanessa Salsbury		TIME COMPLETED:	03:25 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	Licensing Program Analysts (LPAs) Janette Cruz and Jessica Bongardt conducted an announced prelicensing inspection with Vanessa Salsbury, Applicant. The purpose of today's inspection: address the Application for a new large family child care home license that the Applicant submitted to the Department on August 16, 2023. LPA notes that Applicant previously held a large family child care home license #434415831. Application/Record Review: LPA observed that no children were present in the home during today’s inspection. Applicant stated that she is the only adult living in the home. Days and hours of operation will be Monday to Friday from 8:00 AM to 6:00 PM. The Applicant completed the Preventative Health and Safety Child Care Training on 08/28/23 and a copy of the certification is on file. The Applicant has proof of Pediatric CPR and First Aid training (valid 10/27/23) on file. A copy of current TB test, flu, MMR, and Tdap vaccinations for the Applicant are on file. Proof of completion of the Mandated Reporter Training for Child Care Workers (completed on 08/16/23) is on file. The Applicant rents the home and copy of the lease agreement verifying control of property is on file. The completed Property Owner/Landlord Notification (LIC 9151) and Property Owner/Landlord Consent (LIC9149) forms are on file. The Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282) until she obtains insurance coverage. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's inspection. The Applicant agreed to give LPAs a tour of the home (indoor/outdoor) during today's inspection. Physical Plant tour: LPAs observed the home is a single story home with three bedrooms, living room, play room, kitchen, dining area , garage and backyard. There is a working telephone in the home (cell #310-597-3012). The home is clean and orderly, with heating and ventilation for safety & comfort.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

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 3

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: SALSBURY, VANESSA	FACILITY NUMBER: 434416556
	VISIT DATE: 09/15/2023

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

LPAs observed a a locked wood burning stove not being used during daycare hours. LPAs also observed no wall heaters. The off-limit areas inside the home are: master's bathroom, bedroom 2 and garage. Off limit outside of the home : None. There are safe and age-appropriate toys, play equipment, and materials for the children in the home. The Applicant has a designated area in the home (bedroom 1) where a child(ren) can be isolated if exhibiting signs of illness. The home has at least 1 working smoke and carbon monoxide detector in the home (tested by the Applicant during today's inspection). The Applicant has one fully charged fire extinguisher (3A40BC) inside the home. The Applicant states she does not have weapons in the home. LPAs observed Applicant has three pet cats. Applicant assigned one bedroom for pet cats if needed to be kept away from children otherwise the cats can freely roam. All cleaning compounds and medications are adequately stored in high cabinets and inaccessible to children. LPAs reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. The Applicant has a first aid kit in the home, with sufficient emergency supplies, including a no-touch thermometer.

Kitchen tour: LPAs observed the refrigerator and freezer in the home are clean. There are no sharp utensils, cleaning products, lighters/matches, or open bottles of alcohol accessible to children. The Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

Bathroom tour: LPAs observed the bathroom toilet and faucet are clean, safe, and operable. The bathtub/ shower are free of any hazards. All shampoos, soap, medication, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover are inaccessible to the children.

Outdoor tour: LPAs observed the outdoor backyard of the home is fenced, safe, and secure for the children. There are no bodies of water in the backyard. Applicant was advised that outdoor play shall be supervised at all times.

Forms of discipline used by Applicant: talking to children and redirecting. The Applicant understands that children's personal rights should not be violated; including no corporal punishment, supervision of children, transportation of children, requirements for reporting

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: SALSBURY, VANESSA	FACILITY NUMBER: 434416556
	VISIT DATE: 09/15/2023

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

suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed with the Applicant during today's inspection. LPA informed Applicant that fire/disaster drills must be conducted at least once every 6 months and documented..

LPAs reviewed with Applicant 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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.

LPAs 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 [applicant, licensee, or facility representative] 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.

LPAs conducted an exit interview with Applicant, Vanessa Salsbury, that a Large Family Child Care Home license will be approved upon approval of Application by LPA's Manager.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3