434413410-5-21-2019-07-CC-TDON-BCDQ9V-20190521115857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413410
Report Date: 05/21/2019
Date Signed: 05/21/2019 11:59:08 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, BHARVI		FACILITY NUMBER:	434413410
ADMINISTRATOR:	PATEL, BHARVI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 941-9871
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	14	CENSUS: 12	DATE:	05/21/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Bharvi Patel		TIME COMPLETED:	12:05 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) Tuoc Doan conducted an unannounced Annual Inspection of the Family Day Care home. LPA met with Licensee Bharvi Patel and explained the purpose of the inspection. Present during the inspection were 12 children in care, of whom four were infant age (less than two years old). Facility was in compliance with ratio/capacity requirement during the inspection. Licensee was present with her Assistant Provider/Mother-In-Law Nilimaben Patel to provide care and supervision to the children. Licensee stated that she understands her capacity options and she understands that she cannot have more than four infants when there is a total of 12 children in care. Licensee also stated that she understands that she must comply with the ratio and capacity requirements of a small Family Child Care Home license whenever there is only one person providing care and supervision to the children at the home. Days and hours of operation are Monday through Friday from 8:30 AM to 6:00 PM. The home maintains telephone service. The License and Notification of Parents’ Rights were observed to be posted. The home was inspected inside and out. The home was clean and orderly, with heating and ventilation for the safety and comfort of children in care. LPA did not observe flies, other insects, and rodents during the inspection. The observed children’s toys, play equipment and materials were in good condition. Furniture and equipment, such tables, chairs, mats, and play pens, etc. were age appropriate and in good condition. There were no baby walkers observed to be in used. Bathroom used by children was observed to be sanitary and in operating condition. Food preparation area was clean. Off limit areas in the home are: all three bedrooms and master bathroom, and Living Room. There is a Fire Clearance granted for the Family Room and Garage to be used for day care children. The backyard is fenced and is used by children for outdoor activity. There were no bodies of water observed. Licensee stated that there were no weapons such as firearms stored on the premises.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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: PATEL, BHARVI	FACILITY NUMBER: 434413410
	VISIT DATE: 05/21/2019

NARRATIVE

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A fully charged fire extinguisher was observed. Carbon monoxide and Smoke Detectors were tested and proved to be functioning. Log shows that Fire and Disaster drills were last conducted on 03/02/19. The home has not pets. Licensee stated that she does not transport children at this time but she understands that children could not be left unattended in parked vehicles at any time.

LPA reviewed the roster of children in care and obtained a copy. Children’s files were reviewed, which included records of Identification and Emergency Information, Consent for Medical Treatment, Receipt for Parents' Rights Notice, and Immunization. Licensee and Assistant Provider Nilimaben Patel's files were reviewed. Records reviewed include Criminal Record and Child Abuse Index Background Check Clearance, TB clearance, Statement Acknowledging Requirement to Report Suspected Child Abuse, Immunization record for Measles and Pertussis, and required Training. Licensee and Assistant Provider's AB1207 Mandated Reporter certification expires on 05/06/2020.

Licensee and Assistant Provider have renewed their Pediatric CPR/1st Certification in November 2018; however, the training is not from an approved training program. That is, the Certification was not issued by the American Red Cross, American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority (EMSA).

Adults who are over the age of 18 and reside in the home are Licensee, and Licensee's Spouse. They have Clearance for Criminal Record and Child Abuse Index Background Check, and Tuberculosis. 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility. Safe sleep information was reviewed with Licensee. LPA also reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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: PATEL, BHARVI	FACILITY NUMBER: 434413410
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/21/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/27/2019 Section Cited CCR 102416(c)	1 2 3 4 5 6 7	PERSONNEL REQUIREMENTS. The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	BY POC DUE DATE, 05/27/19, Licensee agreed to send to Licensing Office proof of enrollment in a Pediatric First Aid and CPR training course provided by the American Red Cross, American Heart Association, or from a program that has been approved by the EMSA.
	8 9 10 11 12 13 14	Per LPA's review of Certifications, Licensee and Assistant Provider received CPR/First Aid training from "ProFirstAid," a training program that is not approved by the Emergency Medical Services Authority (EMSA). This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14	Completion of the Training shall be no later than 15 Calendar days from today, 05/21/19. A copy of the current and approved Pediatric CPR/First Aid Certification will be sent to Licensing Office to show proof of correction.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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: PATEL, BHARVI	FACILITY NUMBER: 434413410
	VISIT DATE: 05/21/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently does not have any children in care who requires IMS. 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.

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, Online option to pay Annual License fee, Adoption of new Laws, etc.

In the areas that were evaluated, a regulatory violation was observed at the time of the inspection; therefore, a citation was issued. Exit Interview was conducted, where this report, the Citation, Plan of Corrections, and Appeal Rights were reviewed and discussed with Licensee

A copy of this report was provided to facility at the conclusion of the site inspection.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

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