444416835-3-13-2025-07-CC-ALUZ-DEQPM9-20250313112559

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416835
Report Date: 03/13/2025
Date Signed: 03/13/2025 11:26:14 AM

Document Has Been Signed on 03/13/2025 11:26 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LOTZ, SUSAN		FACILITY NUMBER:	444416835
ADMINISTRATOR/ DIRECTOR:	LOTZ, SUSAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(831) 252-9230
CITY:	BEN LOMOND	STATE: CA	ZIP CODE:	95005
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 23	CENSUS: 11	DATE:	03/13/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:35 AM
MET WITH:	Susan Lotz		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

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	At 9:35, Licensing Program Analyst (LPA) Angela Luz met with Licensee Susan Lotz to conduct an unannounced annual RANDOM inspection. Present for this inspection was 11 preschool aged children, 1 fingerprint cleared staff, and 1 fingerprint cleared adult in the home. The home was toured to conduct a Health and Safety Inspection. Days and hours of operation are from Monday – Friday 9AM – 1PM. There are separate groups of children on Mondays/ Wednesdays/Fridays, and Tuesdays/Thursdays. Facility: The OFF LIMIT AREAS are Licensee’s home, laundry/storage building except for the daycare bathroom, and goat and chicken den. The ON LIMIT AREAS are the daycare building, daycare bathroom, and backyard. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. The home is neat and clean with heating and ventilation for safety and comfort. The ISOLATION AREA is the couch inside and the eating tables outside. The outdoor play area is free from defects or dangerous conditions and is fully fenced. There is locked fencing to separate the goat den from the on-limit areas of the backyard. Licensee states that the goats are always in their den. LPA observed a tire swing attached to a sturdy tree with grass underneath and climbing dome with dirt underneath. There is a large play structure that is anchored to the ground with a swing area that has wood chips underneath, and a slide that has sand underneath. Licensee states that they rake the sandbox daily. There have been no changes from the areas previously identified as OFF LIMITS or alterations to existing building or grounds. There are no bodies of water. All hazardous materials and toxins are kept out of the reach of children. Licensee states that any poisons are stored in the laundry room which is OFF LIMITS. Licensee states that there are no firearms in the home. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. LPA reminded that fire extinguishers should be serviced once a year. *Page 1 of 3*

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Angela Luz
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LOTZ, SUSAN	FACILITY NUMBER: 444416835
	VISIT DATE: 03/13/2025

NARRATIVE

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Care and Supervision: There are ample age-appropriate toys that appear to be safe and in good condition. Licensee uses redirection and talking with the child as forms of discipline. Licensee understands that children's personal rights should not be violated, including but not limited to, no corporal punishment, interference with eating, intimidation, or other actions of a punitive nature. Children are treated with dignity, receive safe, healthful, and comfortable accommodations.

Records: The Licensee CPR and First Aid certificate is current and expires 9/3/25. Licensee Mandated Reporter Training for Child Care Providers is current and expires 8/1/25. Licensee was reminded of Mandated Reporter Training (AB1207) and CPR/First aid certifications needs to be renewed every two years. A copy of the licensee’s immunization is on file. The Licensee conducts and documents fire and disaster drills every six months, last drill was on 11/5/24. A current copy of the facility roster was viewed, and a copy was obtained. Licensee has daycare insurance that expires on 9/27/25. Licensee does not administer medication to children in care. Entrance checklist for Family Child Care Home was provided and licensee was reminded of documents to be posted in a prominent, publicly accessible area of the facility.

LPA reviewed five (5) children files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization records. All children’s files viewed today were complete.

LPA, Luz reviewed two (2) staff (S1-S2) files for the following records: Employee rights (LIC 9052), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), immunization records, and required training. Both staff files viewed today were complete and up-to-date.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. 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.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Angela Luz
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LOTZ, SUSAN	FACILITY NUMBER: 444416835
	VISIT DATE: 03/13/2025

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee 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 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, Susan Lotz, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Megan's Law was checked on 2/18/25.

No deficiencies were issued today.
Appeal rights were provided.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee, Susan Lotz.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Angela Luz
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

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