434410246-3-15-2022-52-CC-MESA-CCJSWG-20220315141418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410246
Report Date: 03/15/2022
Date Signed: 03/15/2022 02:14:28 PM

Document Has Been Signed on 03/15/2022 02:14 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:	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: 7	DATE:	03/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Gurdeep Kaur		TIME COMPLETED:	02:30 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 March 15, 2022 at 1:15 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year visit. LPA met with Licensee Gurdeep Kaur and explained the nature of the site visit. Present for this visit were 3 infant and 4 preschool children, Licensee's adult son, Licensee' spouse and Licensee's Assistant. The home currently operates Monday to Friday 08:00am to 06:00pm. The home was toured to conduct a Health and Safety Inspection with the Licensee. The home 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, dining 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 12/01/2021. 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 10/03/2022. Licensee's mandated reporter training was completed 03/18/2021. Licensee owns the house, maintains day care insurance and LIC 9150 in each 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: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: 03/15/2022

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
26
27
28
29
30
31
32

Continuation.....
Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Immunization. The licensee is in ratio today.

Licensee stated that does not transport children at this time. Licensee has a current and valid Driver License. Applicant understands that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions and all vehicle occupants must be secured in an appropriate restraint system.

LPA Estoesta discussed the Lead Poisoning Facts Flyer andhttps://cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

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.

If you have questions regarding a communication you received from CPMB, please visit the Frequently Asked Questions page or contact CPMB at 1-888-422-5669 or Guardian@dss.ca.gov

County of Santa Clara 408-970-2870 and Santa Clara County COVID Support Team 916-262-7553.

If you would like to report an Unusual Incident, please call our Main Office (510) 622 – 2602, there would be two (2) Desk Duty Analyst that are available to assist you.

Contact Information of Santa Clara County Office of Education Childcare Resource & Referral Program 1290 Ridder Park Drive San Jose, CA 95131-2304 Email: childcarescc@sccoe.org Phone: 669-212-KIDS (5437) Hours: Monday – Friday 8:30 a.m.– 4:30 p.m. https://www.childcarescc.org/child-care-application
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: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 03/15/2022

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
26
27
28
29
30
31
32

Continuation.....

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

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.

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, Gurdeep Kaur.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3