434414792-11-16-2022-52-CC-MESA-CL92GF-20221116162304

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414792
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:23:13 PM

Document Has Been Signed on 11/16/2022 04:23 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:	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: 5	DATE:	11/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:51 PM
MET WITH:	Monika Karnik		TIME COMPLETED:	04:00 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, November 16, 2022 at 2:51 pm, Licensing Program Analyst (LPA) Manel Estoesta 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, a volunteer, 3 infants and 2 preschool children. 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 a two story home. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMITS - The Living Room, Dining Room, Kitchen, Family Room, Half Bathroom in the Laundry Room and the backyard is fenced and is used as outdoor activity space. The 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. There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. The home has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector and working telephone. The fireplace is screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 11/09/2022. Licensee owns the house, does not carry childcare liability insurance or a bond and maintain the signed form LIC 282 AFFIDAVIT REGARDING LIABILITY INSURANCE. 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: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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: 11/16/2022

NARRATIVE

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Continuation.

The licensee and licensee's assistant CPR and First Aid certificate and expires in January 2024. The licensee, the volunteer and the Licensee's Assistant completed the Mandated Reporter Child Care Providers training online at https://mandatedreporterca.com/ in December 2021. Licensee, the volunteer and the Licensee's Assistant have records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Licensee that only the Influenza vaccination can be decline with a written declination.

Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, LIC 9150 and Immunization. The licensee is in ratio today.

The Licensee does not transport children currently. Licensee understand that children cannot be left in parked vehicles unattended at any time, the motor vehicles used to transport children in care shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

LPA Estoesta discussed and provided copies of the following;

1. Provider Information for Parents & Families about Lead Poisoning and reminded that licensee must provide the Risks and Effects of Lead Poisoning PUB 515 flyer to parents and families upon enrolling or reenrolling.
2. PIN 20-24-CCP RECENTLY APPROVED SAFE SLEEP REGULATIONS IN EFFECT
3. Guardian New User Information
4. LIC 311 D
5. American Rescue Recovery Plan

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: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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: 11/16/2022

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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

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/inspection-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 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 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.

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.

There are no deficiencies cited on this visit.

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

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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