434415129-5-31-2023-07-CC-SYIP-CSCS63-20230531133516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415129
Report Date: 05/31/2023
Date Signed: 05/31/2023 01:35:22 PM

Document Has Been Signed on 05/31/2023 01:35 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, 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: 10	DATE:	05/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:08 AM
MET WITH:	Sunila Khanna and Rajeev Bharol		TIME COMPLETED:	01:40 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 Required - 1 Year inspection. LPA met with Licensee Sunila Khanna and her spouse, Rajeev Bharol, and explained the reason for the inspection. Present during today's inspection were Licensee, her spouse, her assistant, and 10 children, whom two (2) were infant age. There is an area to post required posting, such as license and notification of parent's rights. The hours of operation are Monday through Friday 7:30AM to 5:30PM. Licensee uses her cell phone. LPA toured the inside and outside of the home with Licensee. The off-limit areas of the home are the entire upstairs and the garage. There are stairs in the home. There a barricaded on the hallway before the stairs; however, children need to pass the stairs in order to go outside. Licensee's spouse placed a barricade on the stairs during today's inspection. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible to children. There are toys and equipment for children. There were no baby walkers observed during today's inspection. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 01/2023. LPA discussed with Licensee to document fire/disaster drills. There is a firearm, such as weapons, stored in the home. Firearms is locked and in an off-limit area. There is no ammunition stored in the home. --------------------continues on 809 dated 05/31/2023 page 2----------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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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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: 05/31/2023

NARRATIVE

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The backyard is used and is fenced. There are equipment for children. LPA reminded to Licensee to check that all equipment is safe and there is no cracks and that there is nothing that could pose a risk to children in care. There were no bodies of water observed during today's inspection.

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. Licensee or her assistant sit with the children when they are napping, but does not document the date, name of child, and the time checked. PIN 20-24 and a example of sleep check log was provided to Licensee.

Licensee does not provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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

A copy of the facility roster was obtained during today's inspection. The records reviewed include immunization record and parent's rights.

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SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

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: 05/31/2023

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---------------continuation of 809 dated 05/31/2023 page 2------------------------

Licensee and her assistant's files were reviewed. The records reviewed include but not limited to Mandated Reporter training. Licensee completed the Mandated Reporter training on 06/07/2021 and her assistant completed training on 02/22/2022. LPA discussed with Licensee that the Mandated Reporter training requires renewal every two years. Her assistant has a valid CPR/1st Aid, which expires on 04/09/2024.

The adults 18 and over living in the home are Licensee and her spouse. Licensee also has two minor children. All adults have cleared fingerprints. LPA reminded Licensee that if her child turns 18 and is still living in the home that they need to obtain fingerprints. 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.

Licensee will submit the following:
- sleep log for infants

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Licensee's spouse, Rajeev Bharol. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/31/2023 01:35 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Licensee or her assistant sits with the children during naptime, but does not document the date, name of the child, and the time checked.
	POC Due Date: 06/07/2023
	Plan of Correction
1 2 3 4	By POC 06/07/2023, Licensee will document the date, name of child, and the time checked for all infants and send proof to Licensing.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC809 (FAS) - (06/04)

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