434410246-1-30-2020-52-CC-MESA-BLBUV5-20200130145433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410246
Report Date: 01/30/2020
Date Signed: 01/30/2020 02:54:38 PM

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:	KAUR, GURDEEP		FACILITY NUMBER:	434410246
ADMINISTRATOR:	KAUR, GURDEEP		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 945-1019
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	14	CENSUS: 10	DATE:	01/30/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	GURDEEP KAUR		TIME COMPLETED:	03:00 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 01/30/2020 at 02:10 PM, Licensing Program Analyst (LPA) Manel Estoesta and Licensing Program Manager (LPM) Wynn Norona, met with licensee GURDEEP KAUR for an UNANNOUNCED REQUIRED ONE YEAR INSPECTION. Present for this visit were 1 infant and 9 preschool children and also a fingerprint cleared assistant provider ARWINDER KAUR. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday to Friday 08:00am to 06:00pm. This is a 2 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, baby room, hallway bathroom, kitchen and the backyard. The OFF LIMIT AREAS are the whole second floor and the garage which will be inaccessible by closed and/or locked doors and visual supervision. There is a gate at the base of the staircase to prevent children accessing the second floor. The ISOLATION AREA is the living room. The backyard is fenced. There are toys and learning materials in the facility. There are no pools, hot tubs or any other bodies of water present during the inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that during the inspection there are no toxins or hazardous items accessible. There are no firearms in the home. The licensee conducts and documents fire and disaster drills at least every six months. Last fire drill conducted 01/15/2020. The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee and assistant provider have current CPR and first aid certificates as well as current immunization. Licensee CPR and first aid certificates expires 11/2020. Licensee's mandated reporter training was completed 12/19/2018. Photocopy of facility roster was obtained. The facility is in ratio today. ****SEE LIC809C FOR CONTINUTION***

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020

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: KAUR, GURDEEP	FACILITY NUMBER: 434410246
	VISIT DATE: 01/30/2020

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. 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 is reminded that any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

No deficiencies are cited during today's date. A notice of site visit and appeal rights was given and must remain posted for 30 days. Exit interview conducted with the licensee.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020

LIC809 (FAS) - (06/04)

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