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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430755945
Report Date: 12/07/2022
Date Signed: 12/07/2022 01:55:33 PM

Document Has Been Signed on 12/07/2022 01:55 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
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: 5DATE:
12/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Cynthia SlackTIME COMPLETED:
02:00 PM
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On December 7th,2022 at 1:10pm, Licensing Program Analyst (LPA) Kassandra Medrano conducted an annual required inspection which included a toured the home and yard, and a review of the required day-care forms with the licensee today. Present in the home is Licensee Kathy, and 2 cleared adults, Raul and Greg. Kathy and Cynthia, and 5 children. Capacity and ratio requirements of children were observed in compliance today. OFF LIMIT AREAS: garage. Adults living in the home are Licensee. 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. During todays inspection, LPA and licensee toured inside and outside of home. The day-care operates Monday- Thursday: 830am-130pm. 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
accessible to day-care children

During todays inspection, both licensees had appointments that required visit to be cut short, visit will need to be continued.

Exit interview conducted and report was reviewed with the licensee, Cynthia Slack. No deficiencies cited during today's inspection
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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