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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415816
Report Date: 08/14/2019
Date Signed: 08/14/2019 04:28:53 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:PRABHA, MADHAVIFACILITY NUMBER:
434415816
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
08/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Prabha, MadhaviTIME COMPLETED:
04:41 PM
NARRATIVE
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Licensing Program Analyst (LPA) Almaraz, Araceli conducted an annual random inspection. LPA met with Licensee, Prabha, Madhavi and explained the nature of today's inspection. Present during the inspection was the licensee. There were four children present, all school age. The hours of operation of the day-care are 8AM to 6PM, Monday through Friday. There are two adults residing in the home; Licensee and spouse Varma, Pranay. Licensee has CPR and First Aid, which has an expiration date of 11/2020. LPA reviewed four children's files the Family Child Care Home Notification of Parents' Rights forms (LIC 995A) were in each file. LPA observed that the Licensee has record of MMR & Tdap vaccinations as well as the opt out form for the flu vaccine. LPA observed a current roster, a current fire disaster/earthquake drills last log 04/2019. Licensee completed Mandated Reporter Training on 09/2018, licensee understands training is to be completed every two years.

Licensee states that there are no weapons in the home. Licensee has no pets. Licensee has day care insurance. LPA observed a working smoke/carbon monoxide detector, 3A40BC fire extinguisher and no bodies of water were observed. There was a shallow pond in the backyard that now has a cover with a lock. LPA observed this cover can support the full weight of an adult. LPA did not observe any heaters in the home. LPA observed two screened fireplaces, they can only be activated with a key. The keys are kept inaccessible to the children in care. LPA inspected the indoor and outdoor areas of the home today. Off limit areas in the home are as follows; Upstairs, laundry room, pantry and garage. Licensee has a gate to prevent access to the upstairs however, is currently only accepting school age children. Licensee showed LPA the pantry, garage and laundry room, all areas are safety compliant. Medication, cleaning products and similar items are stored inaccessible to children. Poisons are locked.

Report Continued on Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: PRABHA, MADHAVI
FACILITY NUMBER: 434415816
VISIT DATE: 08/14/2019
NARRATIVE
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Website for provider resources: http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
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LPA conducted an exit interview with the Licensee and advised the licensee of the pending Department regulation update re: safe sleep for infant children. LPA referred the Licensee to the Department website: www.ccld.ca.gov for additional information. LPA discussed the requirements of AB633 to Licensee.

The following Type B deficiency noted on the attached page (809-D): Appeal rights provided to the Licensee prior to the conclusion of today's inspection.



NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

Final Page of Report Continued from Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: PRABHA, MADHAVI
FACILITY NUMBER: 434415816
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited
CCR
102417(g)
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Operation of a Family Child Care Home :The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: This requirement was not met as evidenced by licensee failed to meet this requirement as observed by LPA. There are two air condtioning untis that are accessible to the chidlren in care. This poses a potential risk to the health and safety of the children in care.
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Licensee will purchase a mesh cover and secure it to the units. Licensee will sent proof of this via mail, fax, email or text photo on or before 08/28/2019 to LPA.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: PRABHA, MADHAVI
FACILITY NUMBER: 434415816
VISIT DATE: 08/14/2019
NARRATIVE
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Off limit areas outside the home are as follows: Locked storage shed, two upper decks. Both upper decks are made inaccessible by gates. LPA and licensee discussed two air conditioning units in the back yard that have direct access to the children in care. Licensee understands the potential risk of the units and would like to minimize any risks it may cause. The front yard is safety compliant and backyard is fully fence.

Supervision of the children was discussed; the Licensee understands a cleared adult must be present in the home during day care hours. Licensees understand that the children must be supervised at all times. The Licensee understands the capacity options and ratio requirements. Licensee understands not to leave children in the car unattended. The Licensee states that there is transporting of children currently. Licensee has valid California drivers license.

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

A review of staff records on 08/13/2019 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 reminded 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.



Report Continued on Page 3*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4