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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415903
Report Date: 11/06/2019
Date Signed: 11/06/2019 11:05:51 AM

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:CHOUDARY, ARTHIFACILITY NUMBER:
434415903
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
11/06/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Choudary, ArthiTIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPAs) Dung Mac and Mel Matos met with Applicant,
Arthi Choudary, for an announced prelicensing inspection. LPAs also observed the Applicant's spouse (Rajiv Choudary) and Applicant's two minor children (ages 2 & 0 years) in the home during today's inspection. The two adults residing in the home are: Applicant and her spouse. The Applicant's minor children ages 0 and 2 also reside in the home. LPAs advised the Applicant that her two minor children living in the home will be counted her capacity since they are under 10 years of age.

The hours of operation will be Monday thru Friday 9:30am-5:00pm. The Applicant provided LPAs with copies of certifications for CPR/First Aid during today's inspection. The CPR/First Aid certifications expire in November 2021. The Applicant is enrolled to take Preventative Health Practices course on December 14, 2019. The Applicant's Mandated Reporter Training for Child Care Workers was completed on October 8, 2019.

The Applicant rents the home and a copy of the lease agreement verifying control of property is on file. The Property Owner/Notification (LIC 9151) and Property Owner/Landlord Consent (LIC 9149) forms are on file. The Applicant is planning to obtain liability insurance for her day care; however, she understands that if liability insurance is not carried, she will have the parents complete the Affidavit Regarding Liability Insurance (LIC 282). The Applicant states that she does not transport children.

LPAs toured the indoor and outdoor areas of the home during today's inspection. LPAs observed sufficient materials, toys, and play equipment for the day care children. There are no stairs in the home. There are no wall heaters in the home. Off limit areas in the home are: Room 2, Room 3, Room 4, bathroom 4, bathroom 5, barricaded kitchen, barricaded fireplace, and attached garage. Off limit areas outdoors: None. LPAs observed an air conditioner unit in the backyard that needs to be barricaded. The Applicant also notes that she wishes to make the left side area of the backyard off limits. LPAs advised the Applicant of what is required to make the left side area of the backyard off limits to the children.

Report continued on Page # 2
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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 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: CHOUDARY, ARTHI
FACILITY NUMBER: 434415903
VISIT DATE: 11/06/2019
NARRATIVE
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LPAs observed fully charged a fire extinguisher sized 2A10BC, functioning smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. The Applicant states that there are no weapons and no pets in the home. LPAs observed that cleaning products, medications, sharp objects, and other similar items are stored inaccessible to children. The Applicant understands that any item(s) labeled as a "poison" must be locked and inaccessible to children. LPAs reminded the Applicant that smoking, baby walkers, and similar items are not allowed in family child care homes.

Forms of discipline used by Applicant: talking to children & redirection. The Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPAs informed the Applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

A review of staff records on October 31, 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. LPAs reminded the Applicant 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.

LPAs discussed the requirements of AB 633 with the Applicant and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. LPAs also discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

Report continued on page # 3
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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: CHOUDARY, ARTHI
FACILITY NUMBER: 434415903
VISIT DATE: 11/06/2019
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LPAs reminded the Applicant that beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

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.

LPAs conducted an exit interview with the Applicant and advised her that a "provisional" small Family Child Care Home license for 8 children will be approved upon completion of the following items and manager approval:

1) Air conditioner unit in backyard is barricaded.
2) The left side area of the backyard is barricaded and off limits

The Applicant agreed to submit picture verifying completion of the items listed above to LPA Mac.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3