434412078-10-1-2019-07-CC-PHEZ-BGJPKT-20191001112341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412078
Report Date: 10/01/2019
Date Signed: 10/01/2019 11:24:01 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:	AGRAWAL, SARIKA		FACILITY NUMBER:	434412078
ADMINISTRATOR:	AGRAWAL, SARIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 735-8571
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	14	CENSUS: 11	DATE:	10/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Sarika Agrawal		TIME COMPLETED:	11:25 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	Licensing Program Analyst (LPAs) Pete Hernandez, Dung Mac, and Mel Matos conducted an unannounced annual inspection at the home today. LPA met with Sarika Agrawal , Licensee, and explained the nature of today's inspection to her. Also present today was Licensee's spouse, Pushpendera Agrawal, and two assistants, Seyda Sultana and Lavejeet Kaur. LPAs observed 11 day care children (4 infants & 7 preschool) present in the home during today's inspection. Hours of operation are Monday - Sunday from 6:00 AM to 10:00 PM. The Licensee, Licensee's spouse and one minor child, age 17 years, live in the home. LPAs toured the indoor or and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPAs observed sufficient materials, toys, and play equipment for the day care children. The home is orderly, and safe for the day care children. There are no stairs or wall heater units inside the home. Off limit areas in the home are the 3 bedrooms, master bathroom, fireplace unit (located in the living room), and attached garage. Off limit areas outdoors are the barricaded air-conditioner unit, locked storage shed, and water heater closet. LPAs observed a fully charged 3A40BC fire extinguisher. There are working smoke & carbon monoxide detectors in the home. LPAs observed a fenced backyard and no bodies of water. LPAs observed a fenced backyard locked shed. The Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, other similar items are in the garage and are inaccessible to children. LPAs reviewed eleven children's files during today's inspection and all the files have the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) and immunization records. The last fire/disaster drill was completed on August 21, 2019. LPAs reviewed a completed Child Care Facility Roster during today's inspection. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 10/01/2019:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2019

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: AGRAWAL, SARIKA	FACILITY NUMBER: 434412078
	VISIT DATE: 10/01/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

A review of staff records on September 30, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs also 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 children was discussed with the Licensee. Licensee understands that she must be present in the home at least 80 percent of the hours the day care is in operation and ensure that the children are supervised at all times. The Licensee understands her capacity options. The Licensee states that she does not transport children and understands that children cannot be left in parked vehicles unattended at any time. Licensee understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick child, requirements for reporting suspected child abuse, unusual incidents/injuries, heat-related illnesses, and requirements for assistant/substitute were also discussed.

LPAs informed Licensee that Licensing forms and Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov

LPAs discussed with and provided Lead Safety Information (AB2370) to the Licensee.

LPAs discussed and provided Safe Sleep Child Care information to the Licensee.

LPAs discussed and provided Healthy Beverages in Child Care information (AB2084) to Licensee.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 10/01/2019:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

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: AGRAWAL, SARIKA	FACILITY NUMBER: 434412078
	VISIT DATE: 10/01/2019

NARRATIVE

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

The Licensee completed the mandated reporter training on 1/18/18 and was reminded that the mandated reporter training must be renewed every two years. Assisitant Lavjeet Kaur completed the mandated reporter training on 1/17/2018 and Assistant Seyda Sultana completed the mandated reporter training on 1/17/2018.

LPAs also provided the e-mail address for the child care advocate if she wishes to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov

Licensee's CPR and First Aid are current and expires on 4/13/2020. The Assistand Syda Sultana's CPR and First Aid is current and expires on 4/13/2020. Assistant Lavjeet Kaur's CPR and First Aid is current and expires in May 2020.

LPAs conducted an exit interview with the Licensee and advised her that no deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

LIC809 (FAS) - (06/04)

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