434409424-7-9-2019-07-CC-MMAR-BDWTEG-20190709143954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434409424
Report Date: 07/09/2019
Date Signed: 07/09/2019 02:40:05 PM

COMPREHENSIVE INSPECTION

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:	PARVIN, SHAHANEWAS		FACILITY NUMBER:	434409424
ADMINISTRATOR:	PARVIN, SHAHANEWAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 239-0231
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95121
CAPACITY:	14	CENSUS: 8	DATE:	07/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Shahnewas Parvin		TIME COMPLETED:	02:40 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 07/09/19 Licensing Program Analyst (LPA) Monica Mathur met with Shahnewas Parvin, Licensee, for an unannounced Annual/Random Inspection. Present in the home were Licensee, an adult Helper and eight day care children (two infants, four preschool and two school age children). LPA observed that a adult Helper present in the day care home did not have Criminal Record Clearances and was not finger printed. Licensee stated she was helping out only for the day because her regular help was away for the week. Type A citation and civil penalty for $100 was issued under Personnel Requirements 102416(d)(1). Facility is in compliance with required ratios today. Days and hours of operation are Monday - Friday from 7:00 AM to 6:00 PM. Adults who are over the age of 18 and reside in the home are the Licensee, Licensee's spouse, a son and a daughter, all have finger print clearances, TB clearance and Criminal Record Statements LIC508 on file. LPA toured the indoor and outdoor areas of the home during today's inspection: INDOOR SPACE: In Use Areas: Living room, Dining room, Family room, Bathroom, Kitchen Off Limit Areas: Master bedroom, 3 other bedrooms, Master bathroom, Attached Garage (All off limit areas and rooms were observed to be locked, safe and inaccessible to children). The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children in the home. LPA observed that a poisonous cleaning product (Easy Off Oven Spray) was stored in a cabinet under the kitchen sink. The cabinet did not have a child safety latch or lock, and was accessible to the children. In 09/26/2018 a citation was issued under the same regulation Operation of a Family Child Care Home 102417(g)(4). This is a second repeat violation under the same regulation within a 12 month period. Type A citation and civil penalty for $250 repeat violation within 12 months was issued during today's inspection. Licensee removed the product immediately and stored it in a cabinet inaccessible to children. This citation was cleared during today's inspection. Due to the issuance of two Type A citations, a Comprehensive Inspection was conducted in the day care home. CONTINUED ON PAGE #2, REPORT DATED 07/09/19

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019

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: PARVIN, SHAHANEWAS	FACILITY NUMBER: 434409424
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/09/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/10/2019 Section Cited CCR 102416(d)(1)	1 2 3 4 5 6 7	PERSONNEL REQUIREMENT 102416(d)(1): Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall:(1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations [...]. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	By POC Due Date 07/10/19 Licensee agreed to send a written statement to CCL stating she understands Personnel Requirements regulations for obtaining criminal record clearance prior to an adult helper's employment in the day care.
	8 9 10 11 12 13 14	Per LPA's observation, an adult helper was present in the home without criminal record clearances, and helping with care for children. Licensee stated she is working only for the day. Licensee failed to obtain criminal record clearance for the helper prior to employement. This poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	Immediate Civil penalty of $100 was issued. Due to the issuance of a Type A Citation, a copy of this Licensing Report and a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be provided and signed by each current and future parent and kept in each child's file.
Type A 07/10/2019 Section Cited CCR 102417(g)(4)	1 2 3 4 5 6 7	OPERATION OF A FAMILY CHILD CARE HOME 102417(g)(4): Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee removed the cleaning product immediately and stored it in a cabinet inaccessible to children. This citation was cleared during today's inspection. Licensee agreed to send to CCL a written statement stating she understands that all poisons will be stored away from children's reach moving forward.
	8 9 10 11 12 13 14	Per LPA's inspection, a poisonous cleaner spray (Easy Off Oven Cleaner) was stored in an accessible kitchen cabinet under the sink. Licensee failed to keep poisons and cleaning compounds inaccessible to children. This poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	This is a repeat violation under the regulation within a 12 month period. A civil penalty of $250 was issued.

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: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019

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: PARVIN, SHAHANEWAS	FACILITY NUMBER: 434409424
	VISIT DATE: 07/09/2019

NARRATIVE

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Furniture and equipment, such as cribs, mats, feeding chairs, and tables were age appropriate and in good condition. There were no baby walkers or bouncers observed on the premise during today’s inspection. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters. A screened fireplace was observed in the Family room. There are no stairs inside the home.
OUTDOOR SPACE: The outdoor space and play equipment were observed to have been maintained in safe condition and free of hazards, with a fenced backyard, and no bodies of water.
Facility appeared to be free of flies, other insects, and rodents during today’s inspection. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Last fire/disaster drill was completed on 06/2019. All required postings were observed on the wall. LPA observed a fully charged 3A40BC fire extinguisher and working smoke / carbon monoxide detectors. The Licensee states that she does not have any weapons or pets in the home.

FILE REVIEW: All children's files reviewed and included all required forms and records required by Licensing. Licensee and Helper files contained Criminal Record and Child Abuse Index Clearance or Exemption, TB clearance, Statement Acknowledging Requirement to Report Suspected Child Abuse, and required Mandated Reporter Training per AB1207. Licensee's certifications for CPR and First Aid are current and expire on 02/2020.

LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who comes 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 80% of the operating hours of the day care and ensure that the children are supervised at all times. The Licensee understands her capacity options and that she cannot have more than 14 children in the home at any time with at least two qualified adults present. Licensee also understands that she must comply with the ratio and capacity requirements of the Family Child Care Home license whenever she or a qualified adult is alone with the children. The Licensee states that she does transport children. LPA reviewed car and child seat safety regulations with the Licensee.

Continued on Page #3. Report dated 07/09/19

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019

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: PARVIN, SHAHANEWAS	FACILITY NUMBER: 434409424
	VISIT DATE: 07/09/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. The Licensee stated that she currently does not have any children in care who requires IMS. 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.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.
Website links for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

childcareadvocatesprogram@dss.ca.gov

In the areas that were evaluated, regulatory violations were observed at the time of the visit. Exit Interview was conducted, where this report, the citations, civil penalties, plan of corrections, and appeal rights were reviewed and discussed with Licensee. Citations are issued on 809-D pages of this report. LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation.

Due to the issuance of two Type A Citations and Civil Penalties during today's inspection, a copy of this Licensing Report and a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be provided and signed by each parent of current and future enrolled children over a period of 12 months, and kept in each child's file. A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ALONG WITH TODAY'S FACILITY EVALUATION REPORT DATED 07/09/19 NEAR THE FRONT ENTRANCE TO THE HOME FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019

LIC809 (FAS) - (06/04)

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