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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414134
Report Date: 05/09/2019
Date Signed: 05/09/2019 12:09:12 PM

COMPREHENSIVE INSPECTION
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:KAUR, KULJITFACILITY NUMBER:
434414134
ADMINISTRATOR:KAUR, KULJITFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 645-5051
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:14CENSUS: 8DATE:
05/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kuljit KaurTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marilou Monico, met with Licensee, Kuljit Kaur, and conducted an annual random inspection. Present in the home were licensee, licensee's husband, adult helper, cooking lady, and eight daycare children including four infants and four preschool age. The daycare is open Monday thru Friday from 9:00 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 March 27, 2021.

The indoor and outdoor areas were inspected. 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 2A10BC fire extinguisher, working smoke detector, functioning carbon monoxide detector, and no bodies of water. Off limit areas include: 3 bedrooms, 1 bathroom, and garage. There is no off limit areas outside the home. Cleaning compounds, medications, sharp objects, and other similar items are stored inaccessible to children. LPA reviewed children's roster and fire drill log. Per licensee, there are no weapons in the home. Eight children's files and a helper's file were reviewed. 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. LPA discussed and provided Licensee with lead information sheets and advised her to provide copies to parents.


(REPORT CONTINUED ON THE FOLLOWING PAGES (PAGES #2 & #3 - REPORT DATED 05/09/19)]:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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: KAUR, KULJIT
FACILITY NUMBER: 434414134
VISIT DATE: 05/09/2019
NARRATIVE
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(CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 05/09/19):

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, deficiencies were cited on the following page:

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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: KAUR, KULJIT
FACILITY NUMBER: 434414134
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2019
Section Cited
HSC
1596.8662(b)(1)
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MANDATED REPORTER TRAINING - On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Licensee states she will submit proof of completion for her and her helper by 06/21/19.
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This requirement is not met as evidenced by: LPA observed that licensee and her helper have not completed the Mandated Reporter Training that began on January 1, 2018. This poses a potential risk to Health, Safety to children in care.
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Type B
06/21/2019
Section Cited
HSC
1597.622
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SENATE BILL 792 - This requirement is not met as evidenced by: License's helper is missing immunizations in measles and pertussis. This poses a potential risk to Health and Safety to children in care.
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Licensee states she will submit proof of immunizations for her helper by June 21, 2019.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3