434415129-11-14-2019-07-CC-SYIP-BHWUW2-20191114145601

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415129
Report Date: 11/14/2019
Date Signed: 11/14/2019 02:57:46 PM

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:	KHANNA, SUNILA		FACILITY NUMBER:	434415129
ADMINISTRATOR:	KHANNA, SUNILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 770-1552
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	14	CENSUS: 9	DATE:	11/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Sunila Khanna And Rajeev Bharol		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced annual random inspection. LPA met with Licensee Sunila Khanna and Licensee's spouse, Rajeev Bharol and explained the reason for inspection. Present during the inspection were Licensee, an Assistant, her spouse, and 9 children, whom 4 were infant age. One more assistant arrived shortly after. All adults present have fingerprint clearance. License, Emergency Disaster Plan, and Notification of Parent's Rights were posted. There is working phone in the home. LPA toured in the inside and outside of the home with Licensee and her spouse. The off-limit areas are the entire upstairs, garage, the kitchen, the living room, and left & right side of the backyard. Licensee is requesting to make the kitchen and the living room accessible to children. LPA inspected the kitchen and living room. LPA discussed with Licensee's spouse that any cleaning supplies would need to be stored inaccessible to children in care. LPA also discussed with Licensee's spouse that the stairs would need to either barricaded on the stairs or another barricade on the other side before the stairs. Licensee's spouse stated they do have another gate and will place it when children use th area. There are stairs in the home, which are barricaded right before the stairs. The home was observed to be clean. Furniture and equipment, such as play yard and napping mats, were observed to be in a good condition. LPA observed that there is sufficient amount of toys for the children in care. LPA did not observe any baby bouncers to be in use during today's inspection. The restroom for children's use was observed to be clean. LPA reminded Licensee to throw away any soiled diapers in the trash. LPA observed a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire drill was conducted on 09/03/2019. Licensee's spouse stated that there are no weapons, such as firearms, stored in the home. -----------------continues on 809 dated 11/14/2019 page 2-------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

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: KHANNA, SUNILA	FACILITY NUMBER: 434415129
	VISIT DATE: 11/14/2019

NARRATIVE

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-------------------continuation of 809 dated 11/14/2019 page 1---------------------------------

The backyard is used and is fenced. The play equipment were observed to be in good condition. There were no bodies of water observed during today's inspection.

Licensee does transport children at this time and understands that children cannot be left alone and unattended in park vehicles.

A copy of the facility roster was obtained. 9 children's files were reviewed during today's inspection. The records reviewed included but not limited to parent's rights and immunization records. LPA reminded Licensee and her spouse about checking that they have received all the required forms and they are completed.

Licensee and her two assistants' file were reviewed. Licensee and her assistants have a valid CPR/1st Aid. Licensee's CPR/1st Aid expires on 02/09/2021. Licensee and her assistants have completed the Mandated Reporter Training. LPA reminded Licensee and her spouse that Mandated Reporter Training requires renewal every two years. Licensee and her assistants have their immunization records for measles and pertussis.

The adults living in the home are Licensee and her spouse. All adults have cleared criminal record clearance, child abuse index clearance, and TB test results. LPA discussed with Licensee and her spouse about any of her own children who are turning 18 need to be fingerprint cleared. applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

------------------continues on 809 dated 11/14/2019 page 3-------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

Page: 2 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: KHANNA, SUNILA	FACILITY NUMBER: 434415129
	VISIT DATE: 11/14/2019

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Licensee stated that she currently does not have any children in care who requires IMS services. 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.

LPA discussed with Safe Sleep and Lead Exposure information. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In areas that were evaluated, no deficiencies have been cited. An exit interview was conducted, where this report was discussed and provided to her spouse. A NOTICE OF SITE VISIT WAS ISSUE AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

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