434404624-9-16-2022-52-CC-MESA-CJBT2U-20220916142118

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404624
Report Date: 09/16/2022
Date Signed: 09/16/2022 02:21:26 PM

Document Has Been Signed on 09/16/2022 02:21 PM - 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	DAVE, ANJANA		FACILITY NUMBER:	434404624
ADMINISTRATOR:	ANJANA DAVE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 719-8450
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	14	CENSUS: 1	DATE:	09/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:49 PM
MET WITH:	Anjana Dave		TIME COMPLETED:	02:45 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	On Friday, September 16, 2022 at 1:40 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year visit. LPA met with Licensee Anjana Dave an explained the nature of the site visit. Present on this visit were one (1) infant, Licensee's spouse and Licensee's daughter. The home’s operating days and hours are Monday through Friday 8:30 AM to 5:00 PM. LPA toured the home to conduct a Health and Safety Inspection with the Licensee. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. Facility maintains telephone service. Facility’s License and Notification of Parents’ Rights were observed to be posted. LPA discussed with Licensee about the personal rights of children in care. LPA did not observe flies, other insects, and rodents during today’s inspection. Disinfectants, cleaning solutions, sharps, and other items that are dangerous to children in care were stored inaccessible and/or out of reach of children. LPA reminded Licensee that poisons need to be locked up. The observed children’s toys, play equipment and materials were in good condition. Furniture and equipment, such as tables, chairs, feeding chairs, and step stool, etc. were age appropriate and in good condition. There were no baby walkers observed. Bathroom for children's use was sanitary. Licensee stated that Licensee prepares food and snacks for the children. No bodies of water was observed. At 1:50 am, LPA observed a gate on the bottom part of the stairway to prevent access to the second story and gate on the Day Care Room by the door. ON LIMIT AREAS - The Play Room, Living Room, Kitchen, Hallway Bathroom and the Backyard. The backyard play area is completely fenced. OFF LIMIT AREAS - The entire second floor, the bedroom next to the play room and the garage which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision. SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: DAVE, ANJANA	FACILITY NUMBER: 434404624
	VISIT DATE: 09/16/2022

NARRATIVE

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The designated isolation area for a child who becomes ill while in care is the living room. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. No fireplace was observed. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year. Licensee owns the house and has childcare liability insurance with Farmers Insurance that will expire on 06/17/2023.

The licensee CPR and First Aid certificate and expires on 11/22/2022 The licensee completed the Mandated Reporter General Training and Child Care Providers training online at https://mandatedreporterca.com/ on 10/11/2020. Licensees have records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed. Child's files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Immunization. The licensee is in ratio today.

Licensee stated that she does NOT transport children at this time. Licensee has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions and all vehicle occupants must be secured in an appropriate restraint system.

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 regardingADA 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

SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: DAVE, ANJANA	FACILITY NUMBER: 434404624
	VISIT DATE: 09/16/2022

NARRATIVE

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LPA discussed the PIN 20-12 CCP, Guardian New User Information and PIN 22-10-CCP UPDATED GUIDANCE FOR CHILD CARE PROVIDERS REGARDING CORONAVIRUS DISEASE (COVID-19).

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee Anjana Dave was reminded that all adults 18 and over living or working in the home, 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 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 [facility representative] 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

For licensing updates, advised Licensee to email childcareadvocatesprogram@dss.ca.gov and request to be added to the email list.

There are no deficiencies cited on this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Anjana Dave.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC809 (FAS) - (06/04)

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