435700337-8-25-2021-52-CC-MESA-C68SW2-20210825141337

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700337
Report Date: 08/25/2021
Date Signed: 08/25/2021 02:13:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ARA, ROSHAN		FACILITY NUMBER:	435700337
ADMINISTRATOR:	ARA, ROSHAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 464-1659
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	14	CENSUS: 1	DATE:	08/25/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Roshan Ara		TIME COMPLETED:	02:30 PM

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On Wednesday, August 25, 2021 1:01 PM, Licensing Program Analyst (LPA) Manel Estoesta conducted an announced Pre-licensing Visit. LPA met with the Applicant Roshan Ara and applicant's spouse and explained the nature of site visit. Applicant submitted a Family Child Care Home (FCCH) Large License application. The applicant old facility number is 434415621. Present on this visit is the applicant's son who is an infant child. Applicant stated that the home will operate from Monday to Friday 8:30am to 6pm.

LPA toured the home to conduct a Health and Safety Inspection. The home is a single story home with 4 bedroom and 2 bathroom. The home is neat and clean with central heating and ventilation for safety and comfort. The home does have a fireplace that is screened to prevent access to children.

The OFF-LIMIT AREAS are the living room, dining area, kitchen, bedroom number 1, 2, 3 and the garage will be inaccessible to children by locked doors, safety gates and visual supervision.

The ON-LIMIT AREAS are the family living room (next to the sun room), sun room, the hallway bathroom and the master bedroom and bathroom and the backyard.

The designated isolation area will be living room. The backyard will be a designated outdoor play area that is fully fenced. The outdoor area has age appropriate toys that appear to be clean and free from defects and dangerous conditions. There are no pools, hot tubes or any other bodies of water. All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged fire extinguisher 3A40BC, working smoke detector, carbon monoxide, mobile phone and fully stocked first aid kit. Per applicant, there are no firearms on the premises.

The applicant owns the property and provided copy of the property deed.

SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ARA, ROSHAN	FACILITY NUMBER: 435700337
	VISIT DATE: 08/25/2021

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Continuation...

The applicant completed the Health and Safety training on and CPR and First Aid is certified, current and expires (ON FILE). A packet of forms pertaining to the children’s files and facility files were reviewed and discussed. The applicant has proof of immunization and has completed part of the mandated reporter training, discussed with applicant it must be renewed every two years.

Individual Medical Services (IMS) policy was discussed.

The applicant 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.

The applicant was reminded that all adults 18 and over, 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 Child Care Center. 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.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

STD 850 Fire Safety Inspection Request completed and granted dated 08/13/2021 (ON FILE).

The home is recommended for a FCCH Large License effective 08/25/2021.

Exit interview conducted and report was reviewed with the applicant, Ara Roshan.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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