434414792-12-23-2021-52-CC-MESA-C9XT55-20211222132459

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414792
Report Date: 12/22/2021
Date Signed: 12/23/2021 10:53:43 AM

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:	KARNIK, MONIKA		FACILITY NUMBER:	434414792
ADMINISTRATOR:	KARNIK, MONIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 321-9831
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	14	CENSUS: 3	DATE:	12/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:33 PM
MET WITH:	Monika Karnik		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	On Wednesday, December 22, 2021 at 12:33 pm, Licensing Program Analyst (LPA) conducted an unannounced Required One (1) Year visit. LPA met with the Licensee Monika Karnik and explained the nature of site visit. Present on this visit were the Licensee's spouse, licensee's daughter, licensee's assistant, 2 infants and 1 preschool child. Days and hours of operation are Monday through Friday from 9:00 AM to 5:30 PM. LPA toured the facility to conduct a Health and Safety Inspection with the Licensee. The home is neat and clean with heating and ventilation for safety and comfort. ON LIMITS - The Living Room, Dining Room, Kitchen, Family Room, Bathroom in the Laundry Room and the backyard is fenced and is used as outdoor activity space. OFF LIMITS - The garage, second floor is Off Limits to the children. A child safety gate was observed at the base of the staircase to prevent children from climbing up the stairs. garage which will be inaccessible to children in care by closed and or locked doors and or a fence with visual supervision. The observed children’s toys, play equipment and materials were safe and age appropriate. Furniture and equipment, such as tables, chairs, mats and cots were age appropriate and in good condition. There were no baby walkers observed. Fireplace was screened. There were no bodies of water observed. Outdoor play equipment were in safe and functioning condition. Licensee stated that there were no weapons such as firearms stored on the premise. Disinfectants, cleaning solutions, sharps, and other items that are dangerous to children in care were stored inaccessible, out of reach, of children. Facility appeared to be free of flies, other insects, and rodents during today’s inspection. A fire extinguisher, and smoke and carbon monoxide detectors were observed. Smoke and Carbon Monoxide detectors were tested and were functioning. Log shows that the last Fire Drill was conducted on 12/02/2021. SEE 809 C.......

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KARNIK, MONIKA	FACILITY NUMBER: 434414792
	VISIT DATE: 12/22/2021

NARRATIVE

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CONTINUATION...

The Licensee stated that she does not transport children at this time but understands that children cannot be left alone, unattended in parked vehicles at any time. Licensee owns the house and maintain signed the forms LIC 282. The licensee is in ratio today.
Facility's roster of children who are provided care was reviewed and a copy was obtained. Children’s files were reviewed, which included records of Identification and Emergency Information, Consent for Emergency Medical Treatment, Receipt of Parent Right's Notice and Immunization.
Licensee and Assistant Provider Dali Ohri's files were reviewed, which included records of Criminal Record and Child Abuse Index Clearance, TB clearance, Immunization record for Pertussis and Measles, and Certification of Completion of AB1207 Mandated Reporter Training. Licensee and Dali's CPR/First Aid Certificate expires on 12/2021.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Individual Medical Services (IMS) policy was discussed. 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: https://www.ada.gov/childqanda.htm.

There are no deficiencies cited on this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Monica Karnik.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC809 (FAS) - (06/04)

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