434413008-5-17-2019-07-CC-MMOO-BC9PN4-20190517112720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413008
Report Date: 05/17/2019
Date Signed: 05/17/2019 11:27:24 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, SAPNA		FACILITY NUMBER:	434413008
ADMINISTRATOR:	AGRAWAL, SAPNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 771-9934
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	14	CENSUS: 10	DATE:	05/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Sapna Agrawal		TIME COMPLETED:	11:35 PM

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 (LPA), Marilou Monico, met with Licensee, Sapna Agrawal, and made an annual random inspection. Present in the home were licensee, her 17-year-old daughter, adult helper and 10 children including 4 infants and 6 preschool age. The daycare is open Monday thru Friday from 8:00 AM to 6:00 PM. Licensee and her husband are the adults residing in the home. Licensee has current CPR/First Aid certifications with an expiration date of October 2019. LPA toured the indoor and outdoor areas of the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean and safe for the daycare children. There is a fully charged 3A40BC fire extinguisher, working smoke detector, functioning carbon monoxide detector, and no bodies of water. Off limit areas in the home: 2 bedrooms and 1 bathroom. Off limit areas outside the home: detached garage and locked storage shed. Cleaning compounds, medications, sharp objects, and other similar items are stored inaccessible to children. Per licensee, there are no weapons in the home. Ten children's files and four helper's files were reviewed. LPA reviewed children's roster and fire drill log. LPA obtained copy of children's roster. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. AB 633 was discussed with Licensee. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. Licensee and her helpers have completed the Mandated Reporter Training. LPA discussed and provided licensee with lead information sheets and advised her to provide copies to parents. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 05/17/2019):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019

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, SAPNA	FACILITY NUMBER: 434413008
	VISIT DATE: 05/17/2019

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 05/17/2019):

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.

As a result of this inspection, there were no deficiencies cited.

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

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019

LIC809 (FAS) - (06/04)

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