434408999-12-17-2019-07-CC-MSMS-BJXVVE-20191217154614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408999
Report Date: 12/17/2019
Date Signed: 12/17/2019 03:47:46 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:	DALAL, SHILPA		FACILITY NUMBER:	434408999
ADMINISTRATOR:	DALAL, SHILPA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 746-0598
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	14	CENSUS: 9	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Shilpa Dalal		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Mel Matos met with Shilpa Dalal, Licensee, for an unannounced annual/random inspection. LPA also observed Licensee's adult daughter/assistant (Himansi Dalal) and nine day care children (3 infants & 6 preschool) in the home during today's inspection. Days and hours of operation are Monday - Friday from 8:30 AM to 6:00 PM. The adults that reside in the home: Licensee and Licensee's spouse. The Licensee's certifications for CPR and First Aid are current and expire on May 20, 2020. The Licensee's assistant's CPR and First Aid certifications are current and expire on May 14, 2021. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last Fire/Disaster drill was completed on November 25, 2019. LPA reviewed nine children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensee and her adult daughter/assistant have completed the Mandated Reporter Training for Child Care Workers and copies of the certificates of completion are on file. LPA reminded Shilpa that she and her assistant will need to retake the Mandated Reporter Training for Child Care Workers every two years. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. LPA observed barricaded stairs inside the home. Off limit areas inside the home (upstairs): one bedroom, one bathroom, and balcony. Off limit areas inside the home (downstairs): one bedroom, one bathroom, one barricaded fireplace (located in the living room), and attached garage. Off limit areas outside the home: one locked storage shed, located in the backyard. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 12/17/2019):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DALAL, SHILPA	FACILITY NUMBER: 434408999
	VISIT DATE: 12/17/2019

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 12/17/2019):

LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any weapons in the home. Licensee states that she has one Maltese dog that is vaccinated and kept in off limit areas during day care hours. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.

A review of staff records on December 17, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the 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.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with at least two qualified adults present. The Licensee understands that she must comply with the capacity & ratio requirements of the small Family Child Care Home license whenever there is only one qualified adult present in the home. The Licensee states that she does not transport children. The Licensee does not administer any medications to the day care children.

No deficiencies issued during today's inspection.

LPA conducted an exit interview with the Licensee and advised her of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

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