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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376624591
Report Date: 05/04/2020
Date Signed: 05/04/2020 02:47:10 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/25/2020 and conducted by Evaluator Keturah Lane
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20200225123750
FACILITY NAME:JAISWAL, NIDHI FAMILY CHILD CAREFACILITY NUMBER:
376624591
ADMINISTRATOR:NIDHI JAISWALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 366-9101
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:14CENSUS: 3DATE:
05/04/2020
ANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Nidhi JaiswalTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Unqualified assistants providing care in Licensee's absence
INVESTIGATION FINDINGS:
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On 5/4/2020, Licensing Program Analyst (LPA) Keturah Lane met with Licensee Nidhi Jaiswal via tele-inspection due to COVID-19 SOE. Also present in the home were licensee's husband and 3 daycare children.

On 3/3/20, LPA Lane observed that staff files were missing mandated reporter training and proof of immunizations for helper, Kalyani Wakade. The facility was cited for the immunizations and mandated reporter on a separate LIC809 dated 3/3/20. Licensee corrected violations on 3/6/20 & 3/19/20. In addition, LPA reviewed the CPR/First Aid certification for Ms. Wakade and found it was not from an EMSA approved vendor. Therefore, there will be an additional Type B citation for not fulfilling this requirement.

(continued on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 51-CC-20200225123750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JAISWAL, NIDHI FAMILY CHILD CARE
FACILITY NUMBER: 376624591
VISIT DATE: 05/04/2020
NARRATIVE
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The Department fully investigated the above allegation and obtained information from the facility file review, documents received from Licensee, and interviews with children, staff members and parents of enrolled children. Based upon this information, the preponderance of evidence standard has been met. The allegation of Unqualified assistants providing care in Licensee’s absence is therefore SUBSTANTIATED.

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiency was cited (refer to LIC 9099-D). An exit interview was conducted with Licensee. A Notice of Site Visit (LIC9213) and Appeal Rights (LIC9058) will be sent along with the report (LIC9099) via e-mail to the Licensee. Licensee will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights. The Notice of Site Visit (LIC9213) must remain posted for 30 days.

(Please see LIC 9099D)
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 51-CC-20200225123750
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: JAISWAL, NIDHI FAMILY CHILD CARE
FACILITY NUMBER: 376624591
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2020
Section Cited
CCR
102416(c)
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The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health & Safety 1596.866. This requirement is not met as evidenced by...
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Licensee will provide written documentation that helper Kalyani Wakade no longer works at the facility OR provide proof of EMSA approved Pediatric CPR/First Aid certification for helper Kalyani Wakade by 6/4/2020.
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Based upon record review and interviews with children, parents and staff, the licensee did not ensure staff member had EMSA approved CPR/First Aid certification which is a potential health and safety risk to persons in care.
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Licensee understands that if Kalyani Wakade plans to work for the facility in the future she must fulfill this requirement before returning to work.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3