013422617-7-27-2022-52-CC-AWRT-CGQUJT-20220727153803

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422617
Report Date: 07/27/2022
Date Signed: 07/27/2022 03:38:08 PM

Document Has Been Signed on 07/27/2022 03:38 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	JOSEPH SELVARAJ, RAJEE		FACILITY NUMBER:	013422617
ADMINISTRATOR:	JOSEPH SELVARAJ, RAJEE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 216-8887
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY:	14	CENSUS: 10	DATE:	07/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Rajee Joseph Selvaraj		TIME COMPLETED:	03:45 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	On July 27th, 2022 @ 1:25pm, Licensing Program Analyst (LPA) April Wright met with licensee Rajee Joseph Selvaraj for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the home by the licensee. Present during the inspection were ten (10) children; eight (8) preschool, one (1) school age and one (1) infant and the fingerprint cleared assistant Deepika Lohani. Hours of operation are 8:30am - 6pm Monday through Friday. LPA toured the faculty to conduct a health and safety inspection. The 2 story home was clean and orderly, with heating and ventilation for safety and comfort of children in care. The isolation area is the couch in day-care room or the garage with assistant which is away from other children in care. On limit areas include: Living / Day-care area, downstairs bathroom, converted garage and backyard. Off-limits areas include: Entire second level of home, kitchen and garage which are and will be made inaccessible by child safety gates, closed and/or locked doors and visual supervision. There is a gate at the bottom of the stairs to prevent access to the upper of the home. There are no pools hot tubs or any other bodies of water present. LPA did not observe any hazardous materials or toxins accessible to children during today's inspection. There are ample age appropriate toys that appear to be safe and in good condition. The backyard has a small play structure with slide and grass cushion to absorb falls. The home has a two (2) fully charged 3A40BC fire extinguishers, working smoke / carbon monoxide detectors and telephone. There is a fire place that is blocked and inaccessible to children in care. Per licensee there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. See LIC809 -C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: JOSEPH SELVARAJ, RAJEE	FACILITY NUMBER: 013422617
	VISIT DATE: 07/27/2022

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LPA requested and reviewed the files of ten (10) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 7-6-2022. The licensee has current CPR/First Aid (expires 9/5/2020) and Mandated Reporter training certificates (4/4/2022) were reviewed are current. The licensee is in ratio today. All required forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. No IMS is being provided. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

Licensee was reminded that all assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Licensee was reminded that California Law requires licensed Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Rajee Joseph Selvaraj.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: April Wright	TELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022

LIC809 (FAS) - (06/04)

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