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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417329
Report Date: 08/08/2023
Date Signed: 08/10/2023 08:33:08 AM

Document Has Been Signed on 08/10/2023 08:33 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:MAYSON, LESLEYFACILITY NUMBER:
434417329
ADMINISTRATOR:MAYSON, LESLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 250-6916
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
08/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lesley MaysonTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Farida Raja, met with Applicant, Lesley Mayson, to conduct an announced pre-licensing inspection. LPA was granted access to the home by the Applicant and explained the purpose of today's visit. Also present in the home were Spouse and two minor children. Per Applicant, the adults that reside in the home are applicant and spouse. The home is a two story with 4 bedrooms and 3 bathrooms.

Days and hours of operation will be Tuesday-Thursday and Saturday from 9am-1pm. Applicant stated that she plans to provide care to children ages 4-7 years at present. LPA reminded Applicant that her children will be counted in the ratio during daycare hours. Applicant stated that she does not plan to provide transportation. Applicant completed her Preventative Health and Safety Training on 04/25/2023 and a copy of the certification is on file. The Applicant's CPR and First Aid certifications expires on 03/2025. Applicant has completed the Mandated Reporter Training for Child Care Workers on 04/27/2023. A copy of current TB test (applicant and spouse), influenza, MMR, and Tdap vaccinations for the Applicant are on file. The applicant has a lease agreement on file. Applicant does not have liability insurance at this time and will issue Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282). Applicant plans to purchase liability insurance in the future.

LPA toured the indoor and outdoor areas of the home with the Applicant during today's inspection. Off limit areas inside the home: entire second level, dining area, kitchen, downstairs closet and attached garage. LPA observed barricaded stairs during today's inspection. LPA observed child proof locks on cabinets in the kitchen and dining area to secure items that are to be inaccessible to children. Off limit areas outside the home: front yard, left side section and storage shed in the right side section. The outdoor space and play equipment were observed to be age appropriate and free of hazards. LPA reminded applicant to follow age recommendations on all play equipment. LPA observed water beads in the outdoor area and asked applicant to avoid play with water beads as children could ingest them. Shade is provided by trees, a pergola and two

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MAYSON, LESLEY
FACILITY NUMBER: 434417329
VISIT DATE: 08/08/2023
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canopies. LPA observed an inflatable pool and reminded applicant that children need to be supervised at all times during water play and the pool needs to be emptied after each use. Backyard is fenced. The gate on the left side section does not close, and LPA asked applicant to repair the lock and send a picture to LPA. There were no bodies of water observed. LPA reminded applicant that garden tools and fertilizers/pesticides need to be stored in the locked shed inaccessible to children. Applicant understands that children must be supervised at all times while outdoors.

LPA observed that the half bath used by children was in operating condition. Toilets and faucet are clean and operable. LPA observed medicines and mouthwash in the cabinet under the sink and asked applicant to either move them to an inaccessible area or have the cabinets secured with a child lock.

Applicant has a working telephone in the home (408-250-6916). LPA inspected home for any health and safety hazards. Areas accessible to children were inspected to ensure that they are clean and orderly. There is sufficient toys, supplies, and equipment for the day care children both indoors/outdoors. Furniture, such as tables, chairs, and shelves, are in good condition. The floors were free of tripping hazards with toys put away in bins. The home has central heating/cooling and ventilation for comfort of children. LPA observed two small aquariums, one in the living area and other on a counter in the dining area.

LPA observed a fully charged fire extinguisher (2A10BC) in the family room and working smoke and carbon monoxide detectors in the living and dining area. LPA informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented. Applicant stated that she has a shot gun and LPA observed that it is stored on a high shelf in the master bedroom with an action and trigger lock. LPA observed ammunition stored separately in a high child locked cabinet in the garage. Applicant does not have any pets in the home. LPA reminded applicant that all cleaning products, toxic agents, medications, and sharp objects need to be stored inaccessible to children. LPA reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. Applicant states that she will provide morning snack to the day care children and children will bring their own lunch. LPA reminded the Applicant that any food/liquid products provided by parents will need to be labeled with each child's individual name(s) and properly stored or refrigerated.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MAYSON, LESLEY
FACILITY NUMBER: 434417329
VISIT DATE: 08/08/2023
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supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Form of discipline will be to use positive discipline. Applicant stated that she will redirect children and help with problem solving. Applicant understands that children's personal rights should not be violated, including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed.

LPA discussed the requirements of Assembly Bill(AB) 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. A $500 immediate civil penalty and $100 per day violation until corrected is assessed for serious violations such as absence of supervision, accessible bodies of water, accessible firearms, refused entry of licensing staff, presence of an excluded person, and violations that result in illness or injury.

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-andresources/safe-sleep, as an additional resource. LPA also informed applicant 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. Licensee does not plan to care for infants at present.

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. Entrance Checklist was provided to the applicant.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MAYSON, LESLEY
FACILITY NUMBER: 434417329
VISIT DATE: 08/08/2023
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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (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 states that a child will be isolated in the living room if necessary due to illness or communicable disease. Applicant has a First Aid kit in a high cabinet in the dining area. PIN 22-02-CCP - Best Practices Related to the Provision of Incidental Medical Services in Child Care Center and Family Care Homes was provided to the Applicant.

On this date, 04/04/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Applicant, Lesley Mayson. A large Family Child Care Home License will be approved upon completion of the following and supervisor approval.
  1. Applicant will remove/child lock medications, mouthwash and similar items from bathroom cabinet and send a picture to LPA.
  2. Applicant will repair gate on the left side section of the home and send proof of repair to LPA.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023
LIC809 (FAS) - (06/04)
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