434415249-11-5-2019-07-CC-MSMS-BHMSLW-20191105125900

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415249
Report Date: 11/05/2019
Date Signed: 11/05/2019 12:59:04 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:	SOROYA, SHAZIA		FACILITY NUMBER:	434415249
ADMINISTRATOR:	SOROYA, SHAZIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 887-2471
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94085
CAPACITY:	14	CENSUS: 5	DATE:	11/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Shazia Soroya		TIME COMPLETED:	01:10 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) Mel Matos met with Shazia Soroya, Licensee, for unannounced annual/random inspection. LPA also observed the Licensee's adult sister, who was visiting the home today, and five children (3 infants, 1 preschool, and Shazia's 4 year old nephew) in the home during today's inspection. Days and hours of operation are Monday - Friday from 8:30 AM to 5:00 PM. The adults that reside in the home are the Licensee and her spouse. The Licensee also has two minor daughters, ages 14 & 7 years, residing in the home. The Licensee and her adult assistant's have valid CPR and First Aid certifications which expire in November 2019. The Licensee states that she and her adult assistant are in process of renewing their CPR & First Aid certifications. LPA reviewed a current Child Care Facility Roster and Fire/Disaster drill log during today's inspection. The last fire/disaster drill was completed on September 9, 2019. LPA reviewed five children's files and observed current and updated immunization records and the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) in each file. The Licensee and her adult assistant completed the Mandated Reporter Training for Child Care Workers in March 2019. LPA reminded the Licensee that the Mandated Reporter Training for Child Care Workers must be taken every two years. LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. LPA did not observe any wall heaters inside the home. There are no stairs inside the home. Off limit areas inside the home: one bedroom, barricaded fireplace (located in the living room), and furnace closet. Off limit areas outside the home: detached garage, and left/right areas of the backyard. LPA observed a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Licensee states that she does not have any pets and weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 11/05/2019):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

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: SOROYA, SHAZIA	FACILITY NUMBER: 434415249
	VISIT DATE: 11/05/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 11/05/2019):

A review of staff records on November 5, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded the Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, 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.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. The Licensee understands her capacity options and she understands that she cannot have more than 14 children in the home at any time with a qualified assistant present. The Licensee understands that she must comply with the capacity and ratio requirements of the small Family Child Care Home license whenever there is only one qualified adult present in the home. The Licensee states that does not transport children.

Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

LPA conducted an exit interview with the Licensee and advised the Licensee that no deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE HOME, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

LIC809 (FAS) - (06/04)

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