<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416728
Report Date: 09/07/2023
Date Signed: 09/07/2023 03:16:45 PM

Document Has Been Signed on 09/07/2023 03:16 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:KASSEL, ALEXANDRIAFACILITY NUMBER:
434416728
ADMINISTRATOR:ALEXANDRIA KASSELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 427-2819
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Alexandria KasselTIME 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) Samantha Yip and Ashley Lopez conducted an unannounced Case Management-Other inspection. LPA met with Licensee Alexandria "Alex" Kassel and explained the reason for the inspection.

LPAs observed that there is an in-ground pool in the backyard, which was not fenced. The window in the children's restroom is facing the backyard where the pool is located. LPA discussed with Licensee that her pool needs to be fenced at all time.

As a result of this inspection, a Type A citation was issued. A civil penalty of $500 was assessed for Immediate $500. Exit interview was conducted and report was reviewed with Licensee Alexandria Kassel. A notice of site visit has been issued and must remain posted for 30 days.

LPA Samantha Yip informed Licensee Alexandria Kassel that this report dated 09/07/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Licensee, Alexandria Kassel, to provide a copy of this licensing report dated 09/07/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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 2
Document Has Been Signed on 09/07/2023 03:16 PM - It Cannot Be Edited


Created By: Samantha Yip On 09/07/2023 at 02:52 PM
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: KASSEL, ALEXANDRIA
FACILITY NUMBER: 434416728

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/08/2023
Section Cited
CCR
102417(g)(5)

1
2
3
4
5
6
7
Operation of a Family Child Care Home. All licensees shall ensure the inaccessibility of pools (in-ground and above-ground),... through a pool cover or by surrounding the pool with a fence.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
By POC 09/08/2023, Licensee stated that she will place fence around pool and send proof to Licensing.
8
9
10
11
12
13
14
Based on observation, the in-ground pool is not fenced, which poses an immediate health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2