434410246-3-1-2024-52-CC-MESA-D2XRGW-20240301120126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410246
Report Date: 03/01/2024
Date Signed: 03/01/2024 12:02:05 PM

Document Has Been Signed on 03/01/2024 12:02 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: 10	DATE:	03/01/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Gurdeep Kaur		TIME COMPLETED:	11:45 AM

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 1, 2024 at 10:30 AM, Licensing Program Analyst (LPA) Manel Estoesta conducted an Required Visit. LPA met with Licensee Gurdeep Kaur and explained the nature of the site visit. Present for this visit were 3 infants and 7 preschool children and Licensee's 2 adult son which also serves as the Licensee's Assistants. The home currently operates Monday to Friday 08:00 am to 06:00 pm. 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 and disaster drills conducted 12/01/2023. The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Licensee owns the house and maintains day care insurance.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

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: 03/01/2024

NARRATIVE

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The licensee's CPR and First Aid certificate expires on 09/17/2024. The Licensee and Licensee's Assistants completed the Mandated Reporter General Training and Child Care Providers training online at https://mandatedreporterca.com/. Licensee and the Licensee's Assistants have records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed. Children’s files were reviewed, which included but not limited to records of Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, LIC 282, LIC 9150, Infant Sleep Log and Immunization Record. The licensee is in ratio today. The Licensee does not transport children at this time.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

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 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: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

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: 03/01/2024

NARRATIVE

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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.

LPA discussed to the Licensee the following,

1. The Santa Clara County Childcare Resource and Referral (R&R) Program continues accepting reimbursement applications for approved Preventative Health and Safety and CPR/First Aid training/courses completed by eligible providers in Santa Clara County.
2. Child care staff and volunteers in California are required to show proof of vaccination against these dangerous diseases: measles, whooping cough, and flu.
3. Declination of Influenza Vaccination Form.
4. Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed.
5. High chairs, car seats, and swings are allowed, but you need to ensure that they are used for their expressed purposes. This means car seats are for transit only and high chairs can only be used for
feeding. Children should not be in them for long periods of time and should be transitioned to appropriate furniture, equipment, or accommodations.

Licensee understood.

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.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

LIC809 (FAS) - (06/04)

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