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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416768
Report Date: 04/13/2022
Date Signed: 04/13/2022 03:42:03 PM

Document Has Been Signed on 04/13/2022 03:42 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:NAKAMURA, MEGUMIFACILITY NUMBER:
434416768
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:58 PM
MET WITH:Megumi NakamuraTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA), James Santos conducted an announced visit today met with applicant, Megumi Nakamura today for the pre-licensing inspection. Licensee's husband, Shinji Nakamura was also present during today's inspection visit. Applicant applied for a small family day care home.

LPA inspected the entire home with applicant. Off limit areas inside the home are two (2) bedrooms, and off limit areas outside are the garage and the two side yard/walkways on the left and right hand sides in the backyard. There are two (2) adults residing in the home: Applicant/Licensee and her husband and their two (2) minor children (5 and 8yos).

The home has smoke and carbon monoxide detectors and a fire extinguisher. There were sufficient age appropriate toys in the day care area. All cleaning products, hazardous and sharp objects are stored and inaccessible to children. Discipline policy was discussed with applicant and she understood that the children's personal rights should not be violated and corporal punishment is not allowed. Applicant will use redirection as form of discipline. Applicant stated she is not planning on transporting children but understood the safety seat belt/car seat requirements. Per Applicant, they don't have any firearms or weapons in the home.

Per review of record, applicant has completed the Preventative Health and Safety training. Applicant's CPR/1st Aid certification is valid until 1/22/2024 and Child Care Provider Mandated Reporter Training (AB1207) is valid until 12/2/2023.

LPA advised applicant of the required "mandated reporter" training for Assembly Bill, AB1207 requirement for Child Care Providers that all staff must complete and renew every two (2) years. The website for the online training is: http://www.mandatedreporterca.com

Continued on next page.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
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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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: NAKAMURA, MEGUMI
FACILITY NUMBER: 434416768
VISIT DATE: 04/13/2022
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Applicant was advised on the regulations that smoking, baby walkers, bouncers, exersaucers and other similar items are not allowed. The following were discussed, isolation of sick children; supervision of children; capacity options; requirements for reporting suspected child abuse; unusual incident/injuries; fire drills practiced at least twice a year and documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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

The Department's website: www.ccld.ca.gov to obtain forms and Title 22 regulations



LPA reminded applicant of the $100 civil penalty per person per day, a maximum of $500 per person (if cited again within 12 months maximum of $3,000 per person) for those adults who have not received fingerprint clearances, are not associated to the license that come in contact with or provide care and supervision to the children.

A review of records during today's inspection indicates that other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA provided applicant with a family child care packet.

Licensure of a small (capacity 8) family child care home license will be granted upon management's review and approval.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC809 (FAS) - (06/04)
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