198020602-10-9-2020-33-CC-NTCG-BU8Q8T-20201009115715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020602
Report Date: 10/09/2020
Date Signed: 10/09/2020 11:57:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	ATHWAL FAMILY CHILD CARE		FACILITY NUMBER:	198020602
ADMINISTRATOR:	SUKHJIT K. ATHWAL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 421-0352
CITY:	SOUTH PASADENA	STATE: CA	ZIP CODE:	91030
CAPACITY:	14	CENSUS: 1	DATE:	10/09/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Sukhjit Athwal - Applicant		TIME COMPLETED:	12:10 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	Licensing Program Analyst (LPA) Nolan Tcheng conducted a pre-licensing inspection today. LPA met with Sukhjit Athwal, Applicant who guided analyst on a tour of the facility. Family members residing in the home are 1 adult and 1 child. Present during the inspection was the applicant's daughter. The applicant is requesting a small family child care home license. Per applicant operation hours will be Monday to Friday, 8:00a.m. to 5:00 p.m. Applicant states she will care for children 0-12 years old. All areas identified on the facility sketch were inspected. This is an apartment complex located on the ground level. The apartment unit is an open floor plan with 1 restroom. Areas of the open floor plan have been labeled: kitchen, activity wall, learning center, living room, baby play area, main play room, nursery, storage closet, and bathroom. There is no fireplace on the property. Areas that are accessible to children are as follows: All areas of the unit are accessible for children. Areas off limits based on facility sketch submitted to children and parents include: None. Rooms that are off-limits need to be made inaccessible during operating hours There is an outdoor space connected to the apartment unit. LPA observed a 3.5 foot fence along the back of the outdoor space that separates the outdoor space from a deep hole. The applicant states that she and an aide will be directly supervising the children during outdoor play time. The applicant and aide will position themselves to be in between the children and the fence. Applicant's Initials ________________. A declaration by the applicant stating safe supervision was completed and obtained during the visit. At 10:10am, the applicant began touring LPA though the apartment unit starting with the entry way which lead directly to the kitchen and main playroom. The kitchen was inspected, and LPA observed a magnetic locks on the cabinet under the sink which stores cleaning compounds. REPORT CONTINUES ON NEXT PAGE 1 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ATHWAL FAMILY CHILD CARE	FACILITY NUMBER: 198020602
	VISIT DATE: 10/09/2020

NARRATIVE

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At 10:15am the play room and living room were inspected and electrical outlets were observed to be covered. The knives are stored in a high cabinet out of reach for children. Cabinets in the kitchen all have magnetic child locks. LPA advised that should the applicant have older children in care that may reach the cabinet, that they be secured. No poisons are kept in the apartment.

Per applicant, there are no pets, firearms, and weapons on the premises. There are toys available for children. At 10:15am, applicant showed LPA the fire extinguisher serviced 07/21/2020, as read by applicant from the receipt. LPA observed Fire Extinguisher was anchored to the wall in the living room area. Applicant also tested the carbon monoxide detector in the baby play area and smoke detectors in the kitchen area. Both sounded off the alarms and heard by LPA to be functional. There are emergency supplies in the storage closet.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 02/23/2020), Pediatric First Aid and CPR (ex. 01/2020).There is emergency supplies on the premises.

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.

REPORT CONTINUES ON NEXT PAGE 2 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ATHWAL FAMILY CHILD CARE	FACILITY NUMBER: 198020602
	VISIT DATE: 10/09/2020

NARRATIVE

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-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Infant Care: Applicant states that she does care for infants. LPA advised the applicant to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The applicant states that she will not sleep infants in a separate room. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided.

Medication: 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

REPORT CONTINUES ON NEXT PAGE 3 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ATHWAL FAMILY CHILD CARE	FACILITY NUMBER: 198020602
	VISIT DATE: 10/09/2020

NARRATIVE

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Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

Per applicant, she does carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files if no liability insurance is carried. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.

The applicant does not have proof of immunization against influenza, pertussis, and measles.
Applicant completed required mandated reporter training on 01/20/2020 Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

LPA consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Parent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection.

LPA advised the applicant how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:
CHILDREN FORMS/RECORDS , FACILITY FORMS/RECORDS , INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME

Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years. The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Exit interview was conducted with Sukhjit Athwal, Applicant at 11:45am, who is in agreement with the above.

REPORT END 4 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4