434408614-4-5-2023-52-CC-MESA-CQLSFQ-20230405135043

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408614
Report Date: 04/05/2023
Date Signed: 04/05/2023 01:51:07 PM

Document Has Been Signed on 04/05/2023 01:51 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:	DEVI, SHANTI		FACILITY NUMBER:	434408614
ADMINISTRATOR:	DEVI, SHANTI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 887-3649
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	14	CENSUS: 5	DATE:	04/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Shanti Devi and Geetam Das		TIME COMPLETED:	02:00 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 Wednesday, April 5, 2023 at 12 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year Inspection. LPA met with licensee Shanti Devi and her daughter Geetam Das as the Licensee's translator. Licensee speaks Hindi. Present for this visit were Licensees's Assistants Vijeta and Mariah, 1 infant and 4 preschool children. The facility currently operates from Monday to Friday 9 AM to 5 PM. The home was toured to conduct a Health and Safety Inspection. The home is a one story home. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, family room, bedroom number 1 (for napping), dining room, kitchen, hallway bathroom and the backyard. The BACKYARD play area is completely fenced. The OFF-LIMIT AREAS are bedroom number 2 and 3, master bedroom, master bath and the garage which will be inaccessible by closed and or locked doors and or a fence with visual supervision. The ISOLATION AREA will be the bedroom number 1. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. The home has a fully charged required fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. The fireplace is blocked to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills. Licensee owns the house, does not carry childcare liability insurance or a bond and maintain the signed form LIC 282 on each children's file 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: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: DEVI, SHANTI	FACILITY NUMBER: 434408614
	VISIT DATE: 04/05/2023

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The licensee and licensee's assistant completed the CPR and First Aid Training and their certificates expires on March 2025 and June 2023. The licensee and the licensee's ssistants will complete the Mandated Reporter General Training and Child Care Providers training online at https://mandatedreporterca.com/
Licensee and Licensee's assistants 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. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, LIC 9150 and Immunization. The licensee is in ratio today. Licensee stated that she does not transport children at this time.

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 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 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. 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: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: DEVI, SHANTI	FACILITY NUMBER: 434408614
	VISIT DATE: 04/05/2023

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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 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 Estoesta discussed, provided copies of the PIN 20-24-CCP RECENTLY APPROVED SAFE SLEEP REGULATIONS IN EFFECT, Child Care Providers AB 1207 - CALIFORNIA CHILD CARE PROVIDERS: MANDATED REPORTER TRAINING https://mandatedreporterca.com/training/child-care-providers, American Rescue Plan Act Survey and Child Care and Development Infrastructure Grant Program.

There are no deficiencies cited on this visit.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee's daughter, Geetam Das.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

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