434413008-8-10-2021-07-CC-MMOO-C5RSCB-20210810134516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413008
Report Date: 08/10/2021
Date Signed: 08/10/2021 01:45:22 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:	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: 9	DATE:	08/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Sapna Agrawal		TIME COMPLETED:	02:00 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	#2 Licensing Program Analyst (LPA), Marilou Monico, met with Licensee, Sapna Agrawal, for a Required - 1 Year inspection. Licensee's husband, licensee's adult daughter (helper), and nine (9) daycare children including three (3) infants and six (6) preschool age were also present. There are three (3) adults residing in the home: licensee, her husband, and her daughter. The daycare is a one storey, three-bedroom and 1 1/2 bath house. The daycare is open Monday to Friday from 8:00 AM to 6:30 PM. LPA toured the home inside and out with the Licensee. Off limit areas in the home: 2 bedrooms and 1 bathroom. Off limit areas outside the home: detached garage and locked storage shed. LPA observed sufficient toys and play equipment for the day care children. Bathroom used by children was observed to be clean and in good condition. There were no bodies of water observed. Per Licensee, there are no weapons in the home. LPA observed a fully charged 3A40BC fire extinguisher, functioning carbon monoxide detector, working smoke detector, and fenced backyard. Cleaning compounds, detergents, sharp objects, and other similar items were stored inaccessible to children. LPA discussed with Licensee 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. Mandated Reported Training can be accessed at www.mandatedreporterca.com. Licensee's Mandated Reporter Training (AB1207) expires on January 23, 2022. Licensee has current Pediatric CPR/1st Aid certifications with an expiration date of November 02, 2021. LPA reviewed nine (9) children's files and a helper's file. Copy of children's roster was obtained. Fire/disaster drill was conducted on May 14, 2021. *Continuation on next page:*

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

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: 08/10/2021

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 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.

LPA reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is 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 her a copy of Safe Sleep Regulations (PIN 20-24-CCP).

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

A 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: 08/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2021

LIC809 (FAS) - (06/04)

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