434415903-12-14-2020-07-CC-DMAC-BWAPJY-20201214102215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415903
Report Date: 12/03/2020
Date Signed: 12/14/2020 10:22:41 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, ARTHI		FACILITY NUMBER:	434415903
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	12/03/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Arthi Choudary		TIME COMPLETED:	09:00 AM

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) Dung Mac conducted an announced case-management tele-inspection via video conference call (FaceTime) with Arthi Choudary, Licensee. Licensee submitted the application to the Department on November 2, 2020. A fire safety inspection request approval was received from Sunnyvale Fire Department on November 23, 2020. Days and hours of operation are Monday to Friday from 8:00AM to 6:00PM. LPA observed one infant daycare child, Licensee’s minor child, and Licensee’s spouse (Rajiv Choudary) in the home during today's tele-inspection. LPA reminded Licensee that her two minor children living in the home will be counted her capacity since they are under 10 years of age. The adults that reside in the home: Licensee and Licensee’s spouse (Rajiv Choudary). All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's tele-inspection. Licensee’s First Aid and CPR certificates are current and expire on 11/2021. Copies of immunization records and a proof of completion of Mandated Reporter Training (completed on 10/8/2019) are on file. LPA reminded Licensee that the Mandated Reporter Training requires renewal every two years. Licensee rents the home and a copy of the lease agreement verifying control of property is on file. Copies of Property Owner/Notification (LIC 9151) and Property Owner/Landlord Consent (LIC 9149) forms are on file. Licensee has liability insurance and understands that if liability insurance is not carried, she will have the parents complete the Affidavit Regarding Liability Insurance (LIC 282). Licensee states that she does not transport children. Licensee agreed to give LPA a tour of the home (indoor/outdoor) via FaceTime during today's tele-inspection.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

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: CHOUDARY, ARTHI	FACILITY NUMBER: 434415903
	VISIT DATE: 12/03/2020

NARRATIVE

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The home is clean and orderly. LPA observed sufficient materials, toys, and play equipment for the day care children. The are no stairs inside the home. The off-limit areas inside the home are as follows: bedroom 1, bedroom 2, bedroom 3, bedroom 4, bathroom 4, bathroom 5, barricaded kitchen, and attached garage. Licensee has a designated area in the home where a child(ren) ce isolated if exhibiting signs of illness.

Licensee states that the home does not have any wall heaters. LPA observed a screened fireplace in the living room. LPA observed a fully charged 2A10BC fire extinguisher. LPA observed the home has working smoke/carbon monoxide detectors (tested by the Licensee during today's tele-inspection). Licensee states that there are no firearms and no pets in the home. Licensee has a first aid kit in the home, which also has a thermometer and sufficient emergency supplies.

LPA observed that detergents, cleaning products, medications, hazardous, sharp objects, and similar items that are dangerous to children in care were stored inaccessible, out of reach of children. LPA reminded Licensee that all poisons must be locked up with a key or a combination of keys.

LPA informed Licensee that smoking is prohibited in the home during daycare hours. Licensee understands and states that nobody smokes in the home. Licensee states that she does not have any baby walkers/inclined sleepers in the home and understands that baby walkers/inclined sleepers are not allowed in the home. Licensee states that she does not have any baby bouncers, jumpers, saucer chairs in the home.

LPA observed kitchen is gated on both ways. The refrigerator and freezer in the home are clean. There are no sharp utensils, lighter/matches, or open bottles of alcohol accessible to children. Licensee understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

The half bathroom which is used by daycare children was observed. Toilet and faucet are clean and operable. No medication, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover were observed.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

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: CHOUDARY, ARTHI	FACILITY NUMBER: 434415903
	VISIT DATE: 12/03/2020

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Off limit areas outside the home: both sides of the yard. The backyard is fenced and is used for outdoor activity space. LPA observed both sides of the home have a locked gate. LPA reminded Licensee that children must be supervised at all time while outdoors. There are no bodies of water observed. Licensee states that there are no thorn trees.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she does not have children who requires IMS at this time. Licensee was provided the information regarding ADA: toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: http://www.ada.gov/childqanda.htm.

A Family Child Care Home packet with updated Licensing forms, “Lead Poisoning Facts Information" Flyer, and "Safe Sleep" Information were mailed to the Licensee prior to today's tele-inspection and Licensee acknowledged receipt of the packet.

Licensee was informed that due to the current Covid-19 pandemic and "Shelter In Place" Order, the Facility Evaluation Report will be emailed to Licensee (email: navadvipa.homecare@gmail.com) with "Read Receipt" notification. Licensee understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit interview and advised Licensee that a large Family Child Care Home license will be approved upon receipt of the following:

1) Off-limit areas of the backyard are clean.

2) Temporary barricades on off-limit areas of the backyard.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020

LIC809 (FAS) - (06/04)

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