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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409242
Report Date: 02/18/2022
Date Signed: 02/18/2022 11:12:22 AM


Document Has Been Signed on 02/18/2022 11:12 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:KAUL, PRIYANKAFACILITY NUMBER:
073409242
ADMINISTRATOR:KAUL, PRIYANKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 680-4230
CITY:DANVILLESTATE: CAZIP CODE:
94506
CAPACITY:14CENSUS: 0DATE:
02/18/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Priyanka KaulTIME COMPLETED:
12:15 PM
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On 02/18/2022 at 10:00 AM Licensing Program Analyst (LPA), A. Curry arrived at the home and conducted an announced Prelicensing inspection. LPA met with applicant, Priyanka Kaul, who submitted an application for a Large Family Child Care Home. Also present was the applicant’s preschool age child and school age child. The hours of operation for the family child care home will be Monday-Friday 7:30am-5:30pm. A tour of the home was completed with the applicant to conduct a health and safety inspection.

The home is double-story and consist of 4 bedrooms, 4 bathrooms, living room, kitchen, dining area, laundry room, activity room, fenced backyard, front yard, and garage. The children will use the bathroom in the hallway located near the laundry room, downstairs bedroom, activity room, and backyard . Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. The off-limits areas are the front yard, kitchen, dining area, living room, laundry room, garage, and the entire upstairs, which consist of 3 bedrooms, 3 bathrooms, and a loft. The off limit areas are inaccessible by a safety gate, closed and/or locked doors and visual supervision. The Isolation area will be an area located near the activity room. The applicant stated that she will use the backyard for outdoor play. The applicant was advised that any area that will be changed to an on limit area will need to be inspected by Licensing prior to use. There were safe toys, play equipment, and materials observed for children. LPA did not observe any bodies of water, toxins, medications or hazardous items that would be accessible to children. The applicant was advised that all poisons and/or hazardous items must be kept in a locked cabinet/drawer or placed out of reach of children. There is a safety gate at the bottom of the stairs that prevents access to the upstairs area. The home is equipped with central heating. The applicant stated there is a firearm in the home. LPA verified the ammunition and firearm are stored separately.



The home is equipped with a fully charged 2A10BC fire extinguisher, working smoke alarm, working carbon monoxide detector, telephone, and first aid supplies. The applicant completed the required preventative health and safety training, which includes 1 hour of nutrition, the required lead poisoning prevention training, and has current CPR and First Aid training which expires on December 18, 2023 respectively.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: KAUL, PRIYANKA
FACILITY NUMBER: 073409242
VISIT DATE: 02/18/2022
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LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted. LPA advised the applicant that the postings need to be in a place that is visible and accessible to the public. LPA reviewed the ratio and capacity of a large family child care home license. 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-and-resources/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.


The applicant is reminded of the following: to review and follow COVID-19 guidelines, to report any injuries or unusual incidents, including COVID-19 exposures and positive results at the facility.


Incidental Medical Services (IMS) policy was discussed. 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.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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. LPA verified that the applicant has a criminal record clearance and is associated to the license. Licensee was reminded of the responsibility as a mandated reporter. The licensee was reminded that the mandated reporter training needs to be renewed every 2 years, at www.mandatedreporterca.com.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: KAUL, PRIYANKA
FACILITY NUMBER: 073409242
VISIT DATE: 02/18/2022
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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 platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


This home will be licensed effective today, 02/18/2022. An exit interview was conducted with Priyanka Kaul. This report will remain on file for 3 years. A copy of the appeal rights was provided.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Ashley CurryTELEPHONE: 510-566-1562
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC809 (FAS) - (06/04)
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