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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434409550
Report Date: 02/13/2023
Date Signed: 02/17/2023 11:00:10 AM

Document Has Been Signed on 02/17/2023 11:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KARUMURI, ARUNAFACILITY NUMBER:
434409550
ADMINISTRATOR:KARUMURI, ARUNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 270-5568
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
02/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Aruna KarumuriTIME COMPLETED:
04:40 PM
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Licensing Program Analyst's (LPA's), Farida Raja and Anna Morales, conducted an unannounced 1- year annual inspection. LPA was granted access to the home by Licensee, Aruna Karumuri, and explained the nature of today’s inspection. LPA observed 2 adults (Aruna Karumuri and Kulwinder Kaur) and 10 children (4 infants, 6 preschool age) in the home during today’s inspection. Licensee was operating within her ratio and capacity requirements of her license. Days and hours of operation are Monday to Friday 8:00 am to 6:00 pm. LPA observed all required posted materials near the front entrance to the home. The adults that reside in the home are Licensee and her husband.

LPA toured the indoor and outdoor areas of the home during today's inspection. Licensee has a working telephone in the home (408-270-5568). The home is clean and orderly. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. The floors were clean and free of tripping hazards. The home has central heating/cooling and ventilation, and is comfortable for children. The home is two story and LPA observed barricaded stairs during today's inspection. Off limit areas inside the home: entire upstairs, downstairs(one living room, kitchen and dining area) and attached garage. Off limit areas outside the home: left and right side sections of the backyard. Backyard is fenced. LPA observed a swing structure in the backyard that is safe and secure for the children. There are no bodies of water.

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. All detergents, cleaning compounds, medications, sharp objects and other similar items are stored inaccessible to children. Licensee has a first aid kit in the home. Licensee understands that smoking is prohibited in the home.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KARUMURI, ARUNA
FACILITY NUMBER: 434409550
VISIT DATE: 02/13/2023
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Drinking water is readily available for children in the home via individually labeled water bottles. Licensee states that parents provide water bottles and milk and licensee provides lunch and snacks for day care children. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored.

LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. Fire/disaster drill was conducted on 11/30/2022. LPA reviewed children's roster. Six (6) children’s files were reviewed during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), and Immunization Records (PM 286/CDPH 286). Licensee states that she does not have liability insurance for the day care and issues the Affidavit Regarding Liability Insurance for Family Child Care Home (LIC 282).

Licensee and One (1) helper's file was reviewed. Licensee has current CPR and First Aid certifications (expiration: 09/2023). Licensee has the required vaccines (MMR, Tdap, & flu shot). Assistant (Kurwinder Kaur) does not have record of vaccinations on file. Licensee stated that she will send a copy to LPA. LPA observed that Licensee and assistant have not completed the required "mandated reporter" training. Licensee's Mandated Reporter Training expired in 2022. LPA's reminded Licensee that Mandated Reporter Training must be renewed by all staff every 2 years. LPA's informed licensee that all the adults in contact with children in her home are required to complete the training. LPA's referred the Licensee to the training website: www.mandatedreporterca.com for additional information on the online training.

Supervision of children was discussed with Licensee and she understands that she or a qualified adult 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 and a qualified assistant must be present. Licensee understands in absence of a helper her license capacity is reduced to 8 and ratio (age of the children) must be observed.

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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KARUMURI, ARUNA
FACILITY NUMBER: 434409550
VISIT DATE: 02/13/2023
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Licensee was provided 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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. 15 minute checks were not completed for children under 2 years. Licensee was informed of the Safe Sleep regulations and given a copy of LIC 9227.

Licensee states that she does not administer any medications to the day care children at this time. 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.

The Licensee states that she does not transport any day care children. LPA's reminded Licensee that if she decides to transport children, children should not be left unattended in parked vehicles and that car seats shall only be used for transportation and shall not be used for sleeping.



Exit interview conducted and report was reviewed with the Licensee, Aruna Karumuri.

As a result of today's inspection, there were 2 TYPE B deficiencies cited and one Technical Violation issued.

Due to Technical difficulties with printer LPA was unable to leave a copy of this report with licensee. LPA will email a copy of this report to Licensee. Appeal rights will be emailed to the licensee.

A NOTICE OF SITE VISIT WILL BE PROVIDED AND MUST REMAIN POSTED FOR 30 DAYS
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/17/2023 11:00 AM - It Cannot Be Edited


Created By: Farida Raja On 02/13/2023 at 04:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KARUMURI, ARUNA
FACILITY NUMBER: 434409550

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee's Mandated Reporter training expired in 2022 and has not been renewed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2023
Plan of Correction
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Licensee stated that she will complete the training and submit a copy to CCL by POC date.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, staff 2 did not comply with the section cited above. Staff 2 is missing the MMR, TDAP and Flu Shot/ OPT-OUT which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2023
Plan of Correction
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Licensee stated she will submit proof of vaccination by POC date.
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023


LIC809 (FAS) - (06/04)
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