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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412038
Report Date: 06/30/2021
Date Signed: 06/30/2021 04:23:35 PM

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:TARE, MADHURAFACILITY NUMBER:
434412038
ADMINISTRATOR:TARE, MADHURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 792-7014
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:14CENSUS: 6DATE:
06/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Madhura TareTIME COMPLETED:
04:35 PM
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#2 Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced Required 1 Year Inspection today. LPA met with Licensee, Madhura Tare. Also present in the home were the licensee's husband, licensee's adult son and 17 year old son, licensee's daughter-in-law, adult helper, and six daycare children including two infants and four preschool age. There are four (4) adults residing in the home: Licensee, her husband, her son, and her daughter-in-law. The home has 4 bedrooms and 2 bathrooms. The daycare is open Monday thru Friday from 9 AM to 5:00 PM.

LPA toured the home inside and out with the Licensee. The home was observed to be in good order and well maintained. There were sufficient toys and play equipment for the day care children. Bathroom used by children was observed to be clean and in good condition.

Off limit areas in the home: all four bedrooms, 1 bathroom, furnace closet, and garage. Off limit areas outside the home: 1 storage shed. There were no bodies of water observed. Per Licensee, there are no weapons and poisons in the home. A fully charged 2A10BC fire extinguisher was observed. LPA observed functioning carbon monoxide and smoke detector. Cleaning products, sharp objects, and other similar items were stored inaccessible to children.

LPA obtained an updated copy of the roster of children in care. LPA discussed with Licensee Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Licensee's AB1207 Mandated Reporter Training certificate expires on July 14, 2021. Licensee's CPR/First Aid expired on March 27, 2021.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TARE, MADHURA
FACILITY NUMBER: 434412038
VISIT DATE: 06/30/2021
NARRATIVE
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A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensees are encouraged to visit 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 reviewed with Licensee and provided a copy and Safe Sleep Regulations (PIN 20-24-CCP).

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she's not planning to provide IMS at this time.

Per review of the Facility fire/disaster drill log, the last drill was conducted in June 4, 2021.

An updated Application for a Family Child Care Home License (LIC 279) and Current Children In Your Home Application for a Family Child Care Home License (LIC 279B) were submitted to LPA during the inspection.

As a result of this inspection, deficiency was cited. See LIC809D page for deficiency.



A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
Page: 3 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TARE, MADHURA
FACILITY NUMBER: 434412038
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2021
Section Cited

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Personnel Requirements: (c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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This requirement is not met as evidenced by: Licensee does not have current Pediatric CPR/1st Aid certification. This poses a potential risk to the health and safety of children in care.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3