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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406420
Report Date: 07/14/2021
Date Signed: 07/14/2021 03:12:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KARVE, SEEMAFACILITY NUMBER:
434406420
ADMINISTRATOR:KARVE, SEEMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 316-5839
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:14CENSUS: 7DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Seema Karve
TIME COMPLETED:
03:25 PM
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#2 Licensing Program Analysts (LPAs), Marilou Monico and Aman Sharma, conducted an unannounced Required 1 Year Inspection today. LPAs met with Licensee, Seema Karve. Also present in the home was licensee's adult helper and seven (7) daycare children including four (4) infants and three (3) preschool age. There are two (2) adults residing in the home: Licensee and her son. The home has 4 bedrooms and 3 bathrooms. The day care is open Monday through Friday from 9:00 AM to 5:30 PM.

LPAs toured the home inside and out with the Licensee. The home was observed to be in good order and well maintained. There were sufficient toys and play equipment for the day care children. Bathroom used by children was observed to be clean and in good condition.

Off limit areas in the home: 2 bathrooms and garage. Off limit areas outside the home: gated right side yard. There were no bodies of water observed. Per Licensee, there are no weapons and poisons in the home. LPAs observed a fully charged 2A10BC fire extinguisher, functioning carbon monoxide and smoke detector, glass covered fireplace, and fenced backyard. Cleaning compounds, detergents, medications, sharp objects, and other similar items were stored inaccessible to children.

LPAs reviewed seven children's files and a staff file. LPAs obtained an updated copy of the roster of children in care. Fire drill was conducted on 06/22/2021. LPAs discussed with Licensee Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Licensee's AB1207 Mandated Reporter Training certificate expires on 01/07/2023. Licensee has current Pediatric CPR/1st Aid certification which expires on 03/2022.

Continuation on next page:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KARVE, SEEMA
FACILITY NUMBER: 434406420
VISIT DATE: 07/14/2021
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A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPAs reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Adoptions of new laws, pay annual fees etc.
LPAs reviewed with Licensee and provided a copy and Safe Sleep Regulations (PIN 20-24-CCP).

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she's not planning to provide IMS at this time.

As a result of this inspection, there were no deficiencies cited.



A NOTICE OF SITE VISIT WAS POSTED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
LIC809 (FAS) - (06/04)
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