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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313610044
Report Date: 08/06/2019
Date Signed: 08/06/2019 11:23:36 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KHULLAR, MADHUFACILITY NUMBER:
313610044
ADMINISTRATOR:KHULLAR, MADHUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 797-9426
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:14CENSUS: 8DATE:
08/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Madhu KhullarTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jeremey McClain met with licensee Madhu Khullar for an unannounced annual/random inspection. LPA observed a census of eight children, which included two infants and six preschool age children. Licensee’s husband was present during today’s inspection. Licensee stated there are no new residents in the home, and all adult residents have criminal record clearances.

LPA toured areas of the home accessible to the children. The off-limit areas are: two bedrooms, the master bathroom, the laundry room, the garage and the right side of the backyard. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed current CPR/First Aid certificate which expires 09/15/2020. LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. LPA reviewed children's records for completeness, as well as the client roster. Licensee provided proof of immunizations for MMR, Pertussis, and influenza/ licensee declines to take the flu shot.

LPA discussed the Provider Information notice 19-08-CCP which discusses new immunization requirements from the Department of Public Health. LPA provided licensee with and updated CPDH 286 for recording children’s immunizations.

LPA observed that hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach. LPA observed a fire place that was properly screened. There is a working telephone in the home. Licensee stated there are no weapons in the home. Licensee’s fire extinguisher, carbon monoxide and smoke detector meet regulation. LPA observed fire drills documented on a calendar, indicating that the licensee is conducting disaster drills at least once every 6 months. Toys appear to be safe and in working order. The backyard is fenced. LPA did not observe any bodies of water on the premises.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: KHULLAR, MADHU
FACILITY NUMBER: 313610044
VISIT DATE: 08/06/2019
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Incidental Medical Services (IMS) policy was discussed and the licensee is not currently providing IMS. 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

LPA provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years.



LPA discussed recent changes in licensing requirements, Safe Sleep Regulations Concepts and provided licensee with Provider Information Notice. LPA also provided licensee with CDSS’ AB 2370 brochure regarding the effects of lead exposure. LPA provided the licensee with the Summer 2019 quarterly update from Childcare Advocates.

Licensee provided LPA with their email for the purpose of being added to the Childcare Advocates distribution of quarterly newsletters.

No deficiencies were issued during today’s inspection.



This report was reviewed with licensee, and an exit interview was conducted. A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
LIC809 (FAS) - (06/04)
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