434416735-8-5-2021-07-CC-SYIP-C5M4G9-20210805190511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416735
Report Date: 08/05/2021
Date Signed: 08/05/2021 07:05:21 PM

Document Has Been Signed on 08/05/2021 07:05 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:	SCHILL, ASHLEY		FACILITY NUMBER:	434416735
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/05/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Ashley Schill		TIME COMPLETED:	04:25 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 Analyst (LPA) Samantha Yip conducted an announced pre-licensing inspection. LPA met with Applicant Ashley Schill and her spouse, Jackson Schill and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a Small Family Child Care (FCCH) license at 3225 Knightwood Way, San Jose 95148. Present during today's inspection were Applicant and her spouse. Applicant also has three children. There is area to post required postings, which include but not limited to notification of parent's rights and emergency disaster plan. There is working phone in the home, which is (669) 333-4998. The hours of operation are Monday through Friday 7:30AM to 6PM. The Applicant rents the home and plans on obtaining daycare insurance. Applicant understands that she needs to use the Affidavit Regarding Liability Insurance if she does not plan on obtaining daycare insurance. LPA toured in the inside and outside of the home with Applicant and her spouse. The off-limit areas of the home are garage, kitchen, entire upstairs, and the left and right side of the backyard. LPA reminded Applicant to ensure all off-limit areas are inaccessible to children. There is a fireplace in the home, which is barricaded. There are also stairs in the home. Applicant has a gate to place on the bottom of the stairs and will be getting a gate to place at the top of stairs leading from the front door and the bottom of the stairs leading to the upstairs. Applicant stated that she will be sending proof to Licensing once stairs are barricaded. All cleaning supplies, disinfectant, and other items that could pose a risk to children were observed to be inaccessible to children. LPA -------------------------CONTINUES ON 809 DATED 08/05/2021 PAGE 2-----------------------

SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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: SCHILL, ASHLEY	FACILITY NUMBER: 434416735
	VISIT DATE: 08/05/2021

NARRATIVE

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------------------CONTINUATION OF 809 DATED 08/05/2021 PAGE 1----------------------------

reminded Applicant that any disinfectant wipes or hand sanitizer needs to be inaccessible to children. There is sufficient amount of toys and equipment for the children in care. Applicant plans on caring from children ages 2 to 17. There were no baby walkers observed during today's inspection. There is fully charged fire extinguisher, functioning smoke detector, and carbon monoxide detector. Applicant stated that there are no weapons, such as firearms, stored in the home.

Applicant plans on using the backyard and the front yard. Only the backyard is fenced. Applicant understands that she needs to supervise children at all times if she uses the front yard. There is play structure in the backyard, which is anchored to the ground. There is a trampoline in the backyard, which Applicant stated that she does not plan on using. Applicant understands that she needs to submit a waiver request to use the trampoline for children in care. LPA also reminded Applicant to ensure that the left and right side of the yard is barricaded or any tools or chemicals and cleanings are locked and/or in an off-limit area.

Applicant stated that she does not plan on transporting children, but understands that children cannot be left alone and unattended in parked vehicles. Applicant also stated that she will not be providing Incidental Medical Services (IMS). IMS Plan was discussed with Applicant. Applicant understands that if IMS is provided that a Plan for Providing IMS will be submitted to Licensing. The forms of discipline Applicant plans on using are redirecting and time-outs. Applicant stating that time outs will not be more than a minute per age of the child. Applicant understands that children's personal rights should not be violated, including no corporal punishment.

Applicant does have a valid CPR/1st Aid, which expires on 05/08/2023. Applicant completed the Preventive Health and Safety training on 05/09/2021. Applicant's immunization record for measles, pertussis, and influenza are on file. Applicant completed the Mandated Reporter Training on 07/15/2021. LPA reminded Applicant that the Mandated Reporter Training requires renewal every two (2) years.

----------------------CONTINUES ON 809 DATED 08/05/2021 PAGE 3---------------------------

SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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: SCHILL, ASHLEY	FACILITY NUMBER: 434416735
	VISIT DATE: 08/05/2021

NARRATIVE

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----------------CONTINUATION OF 809 DATED 08/05/2021 PAGE 2---------------------------

LPA provided and discussed with Applicant the updated Licensing form packet. Isolation of sick children, supervision of children, requirement for reporting suspected child abuse, usual incidents/injuries, and heat related illness were discussed with Applicant. Applicant stated that she will be using the living room as an isolation area for the children. Applicant understands that her own children under the age of 10 would count under her ratio. LPA also discussed with Applicant that fire/disaster drill needs to be conducted every 6 months and documented.

The adult living in the home are Applicant, her spouse, and her father. All adults have cleared criminal record, child abuse index clearance, and TB test. LPA informed Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPA conducted an exit interview with Applicant and LPA advised Applicant Ashley Schill upon approval of Licensing Management, a license for a Small Family Child Care Home will be granted and issued to Applicant and upon completion of the following item:
- proof that stairs are barricaded

SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC809 (FAS) - (06/04)

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