434410840-4-23-2019-07-CC-AALZ-BBHQ4A-20190423115001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410840
Report Date: 04/23/2019
Date Signed: 04/23/2019 11:50:05 AM

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:	SHAH, ROSHNI & SHAILA		FACILITY NUMBER:	434410840
ADMINISTRATOR:	R/S SHAH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 223-7242
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY:	14	CENSUS: 6	DATE:	04/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Shah, Shaila		TIME COMPLETED:	11:55 AM

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Licensing Program Analysts (LPA) Araceli Almaraz and Fermin Capos-Jaramillo conducted an annual random inspection. LPA met with Licensee, Shaila Shah and explained the nature of today's inspection. Present during the inspection were the licensee and licensees spouse/helper Dipak Shah. There were 6 children present, 1 school age, 2 preschoolers and 3 infants. The day-care is open 7:30 am-5:30 pm Monday-Friday. There are 3 adults residing in the home; Licensee, spouse/helper and adult daughter Shah, Roshni. Licensee and helper have current CPR and First Aid which expire on 09/30/2020. LPA reviewed 5 children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPAs observed that the Licensee and helper have a record of MMR & Tdap vaccinations as well as flu vaccine. LPA observed a working smoke/carbon monoxide detector, 3A10BC fire extinguisher and no bodies of water were observed. LPAs did not observe any heaters in the home. LPAs inspected the indoor and outdoor areas of the home today. Off limit areas are as follows; in the home 2 bedrooms. Off limit areas outside are as follows: The left side and rights side, both are fenced. Medication, cleaning products and similar items are stored inaccessible to children. Poisons shall be locked. LPAs observed a current roster, a current fire disaster and earthquake drills last logged 04/09/2019. Licensee states that there are no weapons in the home. Licensee has no pets. Licensee has day care insurance. Licensee and helper completed Mandated Reporter Training on 12/31/2017, licensee understands training is to be completed every two years.

Licensee states currently there is no providing of Incidental Medical Services at this time. 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.

Report continues on page 2***********************************

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019

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: SHAH, ROSHNI & SHAILA	FACILITY NUMBER: 434410840
	VISIT DATE: 04/23/2019

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LPAs reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come 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 the children was discussed; the Licensee understands a cleared adult must be present in the home during day care hours. Licensees understand that the children must be supervised at all times. The Licensee understands the capacity options and does understand that there cannot be more than 14 children in the home during day care hours and a helper needs to be present. The Licensee also understands the required ratio requirements for the large Family Child Care Home License. Licensee understands not to leave children in the car unattended. The Licensee states that there is no transporting of children currently.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

There are no deficiencies during today’s inspection.

LPAs conducted an exit interview with the Licensee and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPAs referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPAs discussed the requirements of AB633. LPAs informed licensee regarding zero tolerance regulations.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019

LIC809 (FAS) - (06/04)

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