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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413309
Report Date: 08/22/2019
Date Signed: 08/22/2019 09:50:20 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:PATEL, VANITAFACILITY NUMBER:
434413309
ADMINISTRATOR:PATEL, VANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 224-2546
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:14CENSUS: 3DATE:
08/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Patel, VanitaTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA) Almaraz conducted an annual random inspection. Almaraz met with Licensee, Patel, Vanita and explained the nature of today's inspection. Present during the inspection was the licensee, Assistant Baxi, Sushma and Volunteer Metha, Mina . Volunteer Metha is finger print cleared. There were three children present, one infant and two toddlers. The hours of operation of the day-care are 7:30 AM to 6 PM, Monday through Friday. There are four adults residing in the home: Licensee, spouse, Patel, Ajay daughters Patel, Esha, Patel Anuja and one minor son. Licensee Patel has CPR and First Aid, which has an expiration date of 02/2020. Assistant Baxi has CPR and First Aid valid until 04/2019. Volunteer Metha has a CPR and First Aid valid until 02/2021. LPA Almaraz reviewed three children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. LPA Almaraz observed that the Licensee Patel, Assistant Baxi and Volunteer Metha have record of MMR & Tdap vaccinations as well as the flu vaccine. Licensee Patel completed Mandated Reporter Training on 11/2017 and understands training is to be completed every two years. Assistant Baxi and Volunteer Metha have completed Mandated Reporter Training. LPA Almaraz observed Volunteer Metha has the sufficient requirements of a fully qualified Assistant.

LPA Almaraz observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher and no bodies of water were observed. LPA Almaraz did not observe any heaters in the home. LPA Almaraz observed a barricaded fireplace. .

Report Continued on Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: PATEL, VANITA
FACILITY NUMBER: 434413309
VISIT DATE: 08/22/2019
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LPA Almaraz inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; the entire upstairs which is gated. Off limit areas outside the home are as follows: None. The left side of the yard is gated however, the children will use it for activities occasionally. The front yard is safety compliant and the back yard is fully fenced. Medication, cleaning products and similar items are stored inaccessible to children. Poisons must be locked. LPA Almaraz observed a current roster, a current fire disaster/earthquake drills last log 08/2019. Licensee Patel states that there are no weapons in the home. Licensee Patel has no pets. Licensee Patel has day care insurance.

Supervision of the children was discussed; Licensee Patel understands a cleared adult must be present in the home during day care hours. Licensee Patel understands that the children must be supervised at all times. Licensee Patel understands the capacity options and ratio requirements. Licensee Patel understands not to leave children in the car unattended. Licensee Patel states that there is transporting of children currently

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

Report Continued on Page 3*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: PATEL, VANITA
FACILITY NUMBER: 434413309
VISIT DATE: 08/22/2019
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A review of staff records on 08/20/2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA Almaraz reminded Licensee Patel 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.

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

There are no deficiencies during today’s inspection.

LPA Almaraz conducted an exit interview with Licensee Patel and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA Almaraz referred Licensee Patel to the Department website: www.ccld.ca.gov for additional information. LPA Almaraz discussed the requirements of AB633 with Licensee Patel.

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

Final Page of Report Continued from Page 3*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3