434416566-1-24-2024-07-CC-JCRZ-CZSQDN-20240124110501

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416566
Report Date: 01/24/2024
Date Signed: 01/24/2024 11:05:30 AM

Document Has Been Signed on 01/24/2024 11:05 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	FERGUSON, MELISSA		FACILITY NUMBER:	434416566
ADMINISTRATOR:	MELISSA FERGUSON		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 569-4272
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/24/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	Melissa Ferguson		TIME COMPLETED:	11:40 AM

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 Analyst (LPA) Janette Cruz conducted an announced prelicensing inspection with Melissa Ferguson, Applicant. The purpose of today's inspection: address the Application for a Large Family Child Care Home license (Change of Location) that the Applicant submitted to the Department on Nov. 30, 2023. The Applicant is currently licensed at 662 Laurie Avenue, Santa Clara, CA 95054 (Facility #434410075). Application/Record Review: LPA observed one infant child (Applicant's nephew) present in the home during today’s inspection. Applicant stated that she and her domestic partner, Haley Becerra, are the only adults residing in the home. Days and hours of operation will be Monday to Friday from 7:00 AM to 4:30 PM. The Applicant completed the Preventative Health and Safety Child Care Training on 11/03/23 and a copy of the certification is on file. The Applicant has proof of Pediatric CPR and First Aid training on 02/24/23 on file. A copy of current TB test, flu (opt-out), MMR, and Tdap vaccinations for the Applicant are on file. Proof of completion of the Mandated Reporter Training for Child Care Workers (completed on 12/14/23) 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. Fire clearance was granted on 01/22/2024. 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 LPA a tour of the home (indoor/outdoor) during today's inspection. Physical Plant tour: LPA observed the home is a two- story home with five (5) bedrooms, (3) bathrooms, living room, family room, kitchen, dining area, garage and backyard. There is a working telephone in the home (cell #408-569-4272). The home is clean and orderly, with heating and ventilation for safety & comfort.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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: FERGUSON, MELISSA	FACILITY NUMBER: 434416566
	VISIT DATE: 01/24/2024

NARRATIVE

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LPA observed a barricaded fireplace and no wall heaters. The off-limit areas inside the home are: barricaded stairs, entire second floor, 1 downstairs bedroom and attached garage. Off limit areas outside of the home : left side of the backyard. 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 (family room) 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 (2A10BC) inside the home. The Applicant states she does not have weapons in the home. LPA stated that she will have two pet dogs in the home (1 large, 1 small dog) once she starts child care operations at this location. Licensee stated that the pets shall be kept away from children. All cleaning compounds and medications are adequately stored in high cabinets and inaccessible to children. LPA 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: LPA 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: LPA 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: LPA 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

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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: FERGUSON, MELISSA	FACILITY NUMBER: 434416566
	VISIT DATE: 01/24/2024

NARRATIVE

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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 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.

LPA 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.

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

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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