434412574-2-2-2023-07-CC-PHEZ-CNNP6V-20230202100257

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412574
Report Date: 02/02/2023
Date Signed: 02/02/2023 10:03:05 AM

Document Has Been Signed on 02/02/2023 10:03 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	KUMARI, MANJU		FACILITY NUMBER:	434412574
ADMINISTRATOR:	MANJU KUMARI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 996-0387
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	14	CENSUS: 5	DATE:	02/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Kumar Manju		TIME COMPLETED:	10:30 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 2/2/2023: LPA, Pete Hernandez, arrived for a Required - 1 Year inspection. LPA was greeted at the door by Manju Kumari. LPA explained the purpose of the visit. There were 9 children present at the time of the inspection; 1 infants and 4 preschoolers. Three helpers were also present. The adults that reside in the home are the Licensee, her adult daughter Mekhla, her husband Gopal and her mother Pano. Hours of operation are Monday through Friday 7:00am to 6:30pm. On 2/2/2023: LPA observed that detergents, and cleaning compounds, and poisons were inaccessible to children in the kitchen under the sink with a child locks, ,under the bathroom sinks, and in the back yard. All cleaners and poisons are kept in the garage or in the Licensee's bedroom inaccessible to the children. Licensee does have a current CPR/First Aid card and it expires on 11/1/2023. LPA toured the indoor and outdoor areas of the home during today's visit. LPA observed Parents’ Rights Poster PUB393, Personal Rights, and Emergency Disaster Plan posted in the home. The Licensee has a working telephone in the home. LPA observed sufficient materials and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. Off limit areas in the home are the 3 bedrooms, and 1 bathroom. LPA observed there are no stairs in the home. Off limits out side is the backyard where the laundry area is in a locked closet. Also off limits in the backyard is a locked shed. LPA observed the back yard is fenced and the licensee uses the back yard as a playground. LPA observed 2 fully charged 3A40BC fire extinguishers. LPA observed operational smoke and carbon monoxide detectors. Licensee stated that there are no firearms or other dangerous weapons in the home. LPA did not observe any bodies of water at the home. Licensee keeps a current Childrens Roster and Fire Drill Log. Most recent entry on the fire drill log was 11/15/22. Licensee provided copies to the LPA. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 02/2/2023):

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KUMARI, MANJU	FACILITY NUMBER: 434412574
	VISIT DATE: 02/02/2023

NARRATIVE

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LPA reviewed the files of 5 children. All required documentation was in the files.

A review of Staff records indicates that all persons that require a caregiver background check have received criminal record and child abuse index clearance or exemption. LPA informed Licensee of the applicable civil penalties for any adult who has not received fingerprint clearances, is not associated to the license and who comes in contact with or provides 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.

LPA reviewed the Licensee’s and 2 staff files and documentation. LPA observed that the Licensee and staff have completed the required Mandated Reporter training (AB1207). LPA observed the required immunizations against Pertussis, Measles and an Influenza on file for the Licensee. Supervision of children was discussed with the Licensee and does not transport children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list, childcareadvocatesprogram@dss.ca.gov.
The Mandated Reporter Training (AB1207) can be completed at the website listed. http://www.mandatedreporterca.com. LPA discussed and provided Lead Safety Information (AB2370) with the Licensee.

REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 02/2/23)

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KUMARI, MANJU	FACILITY NUMBER: 434412574
	VISIT DATE: 02/02/2023

NARRATIVE

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Licensee and assistants have current Mandated Reporter Certificates. LPA discussed Senate Bill 792, 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, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

LPA Hernandez was provided with a current copy of the children's roster.

LPA discussed the Individual Infant Sleeping Plan form 9227. Licensee already uses this form. She also keep a separate sleep log for the infants.

Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted. A copy of this report was discussed and left with the Licensee, Manju Kumari, whose signature on this form confirm receipt of these documents.

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

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

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