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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414244
Report Date: 09/12/2023
Date Signed: 09/12/2023 01:08:35 PM


Document Has Been Signed on 09/12/2023 01:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:GENIUS KIDS-MILPITASFACILITY NUMBER:
434414244
ADMINISTRATOR:RENUKA SHARMAFACILITY TYPE:
850
ADDRESS:495 JACKLIN ROADTELEPHONE:
(408) 610-4000
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:50CENSUS: 37DATE:
09/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director Renuka SharmaTIME COMPLETED:
01:30 PM
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On Tuesday, September 12, 2023, at 10 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management Visit due to an Incident. LPA met with the Director / Licensee Renuka Sharma. Present on this visit were 37 preschool children and 8 staff. Facility operates Monday and Friday 8am to 6:30pm.

On Friday, September 8, 2023, at 12 pm, in Preschool Room #2, C1 was running, tripped and C1 hit C1's mouth on the edge of the room's stage. S1 stated that it happened during the children's lunchtime, S1 was supervising 5 children in that room including C1. S1 saw the incident approximately 5 feet away from C1, S1 immediately rushed to C1, checked C1's face and it was bleeding and lost one tooth. S1 performed first aid and informed the Director. The Director took the C1 to the front office and asked S2 called the parent. C1's mother came and picked up C1 at 12:27 pm. C1 was brought to the Emergency Care that day and C1 attended the day care the following Monday. The Director stated that C1 was "Okay." C1 had a follow up doctor's appointment today. The Director stated that on 09/08/2023, she left a voicemail and sent an email to the Licensing Office about the Incident. LPA verified that the attempted contact was to the San Jose Child Care Regional Office.
LPA informed the Director to report an Unusual Incident, please call our Main Office (510) 622 – 2602, there are two (2) Desk Duty Analyst that are available to assist you. You can also send an email to CCLOaklandSouthChildCare@dss.ca.gov or fax to (510) 622 – 2641. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.

No deficiencies were observed at the time of the visit. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Director Renuka Sharma.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
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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