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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412078
Report Date: 04/21/2023
Date Signed: 04/21/2023 03:46:15 PM


Document Has Been Signed on 04/21/2023 03:46 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:AGRAWAL, SARIKAFACILITY NUMBER:
434412078
ADMINISTRATOR:AGRAWAL, SARIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 306-1927
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:14CENSUS: 10DATE:
04/21/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Sarika AgrawalTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Sarika Agrawal, Licensee, for an unannounced case management inspection. LPA also observed 10 day care children (3 infants & 7 preschool) and one adult assistant, Chandrakala Karneedi, in the home during today's inspection.

LPA reminded Sarika that a qualified adult assistant must be present in the home whenever there are more than eight day care children present. LPA also reminded Sarika that an adult assistant must also have current CPR/First Aid certifications if left alone with the day care children.

Licensee's CPR/First Aid certifications expire in May 2023. Licensee states that she will enroll herself and her adult assistant in a course to renew the CPR/First Aid certifications. Licensee agreed to submit proof of enrollment & renewed certifications to LPA.

Exit interview conducted and report was reviewed with the Licensee, Sarika Agrawal. No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023
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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