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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430755945
Report Date: 12/14/2022
Date Signed: 12/14/2022 11:37:13 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/14/2022 11:37 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SLACK, MARGARET & HONHOLT, KATHLEENFACILITY NUMBER:
430755945
ADMINISTRATOR:SLACK, CYNTHIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 356-8286
CITY:LOS GATOSSTATE: CAZIP CODE:
95032
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/14/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cynthia Comeau-Slack & Kathy HonholtTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kassandra Medrano conducted an annual required continuation inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee's today. Present in the home are the two licensees, and 10 children. Capacity and ratio requirements of children were observed in compliance today. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, 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. Day-care area is clean, orderly, and equipped with age-appropriate toys and equipment for the children. No baby walkers, bouncers, exercausers, etc. allowed to be used during day-care hours. Home has proper lighting and ventilation. Home has a working telephone, a working smoke and carbon monoxide detector, and a fully charged 2A10BC fire extinguisher. Licensee states there are no bodies of water on the property. There are no detergents, or cleaning products easily accessible to day-care children. Licensee states there are no guns or weapons of any kind in the home. The yard is fenced. Licensee’s CPR and First Aid has expired, and showed proof of enrollment into a CPR class. Emergency drills are conducted at least once every six months and properly logged. Licensee provides daily snacks and parents are required to bring their children lunch. Isolation of sick children reviewed/discussed. Children’s roster was reviewed and is complete and up to date. Children's files were reviewed and are complete. Supervision and transportation of children was discussed. The licensees do not have day-care insurance and has parent affidavit in all children’s files. Capacity options were reviewed. Licensee understands that care cannot be provided for more than the capacity as stated on the license. Requirements for reporting suspected child abuse was discussed, as well as reporting requirements for unusual incidences. All required postings are properly posted (License/Parent’s Rights poster/Emergency Disaster Plan and Earthquake Preparedness Checklist).
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SLACK, MARGARET & HONHOLT, KATHLEEN
FACILITY NUMBER: 430755945
VISIT DATE: 12/14/2022
NARRATIVE
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Licensee was reminded that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza,pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. Licensee was informed about the Provider Information Notices (PINs) on CCLD website. The licensees were not aware of the requirement of repeating the mandated reporter training every two years. LPA reminded about Mandated Reporter Training available on CCLD website (www.ccld.ca.gov or www.mandatedreporterca.com). LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LIcensee stated that children do not nap in care 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. This report and appeal rights were discussed with Licensee. This report must be available in the
facility for public review. To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to [email protected]. 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.

Notice of Site Visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee's, Kathy and Cynthia.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
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Document Has Been Signed on 12/14/2022 11:37 AM - It Cannot Be Edited


Created By: Kassandra Medrano On 12/14/2022 at 11:00 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SLACK, MARGARET & HONHOLT, KATHLEEN
FACILITY NUMBER: 430755945

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2023
Section Cited
CCR
102416(c)

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102416 (c) Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This regulation was not met as evidenced by:
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Prior to second inspection, licensee enrolled into the online portion of the CPR process. On or before 1/27/2023 licensee will submit proof of either completion or enrollment into in person training
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During review of records it was observed that the two licensee's expired 11/2022. Due to licensees enrollment into online portion of CPR training.This poses a potential health and safety risk to children.
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Type B
01/27/2023
Section Cited
HSC1596.8662(b)(1)

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(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement was not met as evidenced by:
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Licensee's stated that they will complete training on or before 1/27/2023 and submit certificates for RO to review
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Upon review of licensee's files and conversation with licensees it was observed that both licensees have not completed renewal training. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Diana Stephenson
LICENSING EVALUATOR NAME:Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2022


LIC809 (FAS) - (06/04)
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