198020602-8-25-2021-33-CC-BBAT-C68RZH-20210825132759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020602
Report Date: 08/25/2021
Date Signed: 08/25/2021 01:28:07 PM

COMPREHENSIVE INSPECTION

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: 12	DATE:	08/25/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Sukhjit Athwal, Licensee		TIME COMPLETED:	01:30 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) Bardo Baluyot conducted an unannounced required annual inspection today. LPA met with Licensee, Sukhjit Athwal. Per Licensee, family members residing in the home are 1 adult and 1 child. Licensee's daughter was present during inspection. Per Licensee, operation hours are Monday to Friday, 8:00 AM to 5:00 PM. LPA obtained the roster and observed three staff with 12 children. 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 are 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. All areas of the unit are accessible for children. There are no off limit spaces. There is an outdoor space connected to the apartment unit. LPA observed the outdoor space to be surrounded by a fence with adequate shade and age appropriate play equipment for children in care. LPA observed staff standing next to a 3.5 foot fence along the back of the outdoor space that separates the space from a lower level yard of the property next door which has about a 4-5 foot drop. The Licensee stated that staff always provide direct supervision while the children are having outdoor play time. The Licensee signed/initialled a declaration during the pre-licensing inspection stating that safe supervision will be provided at all times when children are using the outdoor area. Per Licensee, she is submitting a declaration to transport children via wagons to the park for outdoor play twice a week. Per Licensee, each wagon holds up to four kids and is equipped with a 5 point safety restraint for each child and that all parents have signed waiver/permission slips permitting transport. Forms will be emailed by COB. PG 1 OF 2

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: 08/25/2021

NARRATIVE

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At 10 AM, LPA did a self guided tour the apartment unit starting with the back entry way which can be accessed through a self latching gate adjacent to the front door and leads directly to the outdoor play area at the rear of the unit. LPA inspected nap area and observed one infant sleeping in a sleep sack in one of the two cribs available. LPA also observed several folded mats available for older kids to nap. LPA inspected the single closet which only contained art supplies and supplies for children's activities. LPA did not however observe any of Licensee's or Licensee's daughter clothing or personal belongings anywhere in the home. LPA also inspected another closet which Licensee stated was intended for a washer and dryer but is only being used as storage. The kitchen was inspected and LPA observed magnetic locks on all cabinets including the cabinets under the sink which stores cleaning compounds. LPA observed freezer to be mostly bare. LPA observed no other food in the fridge except for children's individually labelled food which Licensee confirmed was provided by parents. Photos were taken. Per Licensee, she provides AM snack and PM snacks only.

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 (EXP. 10/2021) must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.
-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.

PG 2 of 2

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: 08/25/2021

NARRATIVE

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-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 which can be emailed to mproincidentreports@dss.ca.gov)
-Fire and safety drills must be performed every six months and documented for review by the Department. (Last drill 7/2021)
-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.
-Licensee 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 does care for infants. LPA advised Licensee to sleep infants where the infant can be directly supervised and should be physically checked on periodically while sleeping. 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. Per Licensee, there are not children with IMS at this time. 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
PG. 3 of 4

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: 08/25/2021

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LPA discussed with Licensee concerns that it does not appear that Licensee lives in the facility due to the aforementioned details about no personal effects for her and her daughter being observed anywhere in the home. LPA asked to see a current driver's license (photo taken) and Licensee states that it still reflects previous address. Per Licensee, she is in the process of a separation which daughter is unaware of. Per Licensee, after business hours, she and her daughter have dinner at father's residence and daughter sleeps at that residence. Per Licensee, once she puts daughter to bed, Licensee sleeps at the day care facility/home then returns to pick up daughter and brings her back to the day care home. LPA requested the address for the other residence, but upon discussion with child's father, child's father did not want to disclose address. LPA advised Licensee that management will be informed of situation and additional review and declarations may be requested of her.

LPA reviewed 2 children’s files and 3 staff files. Aside from concerns regarding the Licensee residing full time at the home, no deficiencies were observed by the LPA and no citations were issued in accordance with California Code of Regulations Title 22.

Per applicant, there are no dual licenses at this address and she does carry liability insurance or a bond in accordance with standard established by Family Child Care statute. Signed statements (LIC282) are 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.

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

The exit interview was conducted with Licensee Sukhjit Athwal at 1:15 PM. This report along with a copy of the appeal rights was provided to the Licensee and Appeal Rights explained.

END OF REPORT

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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