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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416379
Report Date: 07/29/2019
Date Signed: 07/29/2019 06:31:17 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:BALLA, SARAFACILITY NUMBER:
444416379
ADMINISTRATOR:BALLA, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 588-4225
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY:14CENSUS: 0DATE:
07/29/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Sara Balla TIME COMPLETED:
06:45 PM
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Licensing Program Analyst (LPA) Zaid Hakim conducted an Announced Pre-Licensing Inspection at the prospective facility today. Upon arrival, LPA met with Ms. Sara Balla, Licensee Applicant. The Licensee Applicant, one other adult, and two minor children are the only individuals that reside in the home and all adults maintain valid fingerprint clearance. Days and Hours of operation will be Monday through Friday 08:30am to 1:00pm. The applicant maintains valid pediatric CPR and First Aid certification with an expiration month of 06/2021, has completed Family Child Care Home Orientation in 04/2019, is enrolled to complete the 8 hour Preventive Health, Safety, & Nutrition training in 09/2019, and has completed the required Mandated Reporter Training per AB 1207 in 06/2019. LPA toured all indoor and outdoor day care areas during the inspection. The Applicant has obtained liability insurance and has agreed to submit a copy to Community Care Licensing (CCL) following this inspection. The Applicant understands fingerprint clearance and immunization + TB requirements for all adults that reside in a licensed family child care home.

LPA toured all indoor and outdoor day care areas during the inspection. The day care areas approved for use include: the entire downstairs which consists of the living room (main activity room), two bedrooms (class rooms), a kitchen, one restroom, the fenced outdoor play area, and the outdoor garden play area. All other areas / bedrooms in the home are off-limits which includes the entire upstairs which consists of four bedrooms, three bathrooms, the kitchen, the dining room, the living room, the garage, and the detached unit (not a separate parcel number). Children will enter the day care through the downstairs door and the applicant has areas designated for required postings, children's personal items, and children / personnel files. LPA observed the storage of toxic cleaning supplies or potentially dangerous household items to be stored inaccessible to children. LPA observed at minimum 1 fully charged 2A10BC fire extinguisher, functional smoke and carbon monoxide detectors, and first aid supplies in the home. The applicant has been informed that all fire safety detectors / equipment are to be maintained or replaced at least once every 12 months. There are fireplaces in the home located in the off-limits living room upstairs which is secured with an enclosed covering and in the on-limits downstairs living room which is also secured with a front gate covering.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/29/2019):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
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: BALLA, SARA
FACILITY NUMBER: 444416379
VISIT DATE: 07/29/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #3 - REPORT DATED 07/29/2019):

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

The applicant has been informed that upon arrival children must be removed from car seats, that bouncers are prohibited from Family Home Day Cares, and that children may not be held in high chairs when not feeding or preparing for feeding time. LPA and the applicant discussed the Effects of Lead in Drinking Water, Safe Sleep Environments, Active Shooter awareness and the Community Care Licensing Division website and discussed access to general updates, changes to Title 22 regulations, health and safety codes, the role of the Licensing Program Analyst (LPA) and other ongoing licensee requirements and responsibilities. LPA advised that licensing forms and all other information can be found at: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

LPA advised the Applicant of the required Immunizations (MMR, Tdap, Influenza *Optional) for all individuals who provide care and supervision to day care children and the "Mandated Reporter" training that all staff will be required to complete starting January 1, 2018. LPA referred the Applicant to the Department website to access the training:
https://mandatedreporterca.com/

Based on today's inspection, the facility physical plant has been APPROVED for licensure pending completion of the items listed below and Community Care Licensing Management Approval:

- Incidental Medical Services Plan
- Confirmation of Control of Property
- Submission of Training Enrollment: 8 Hour Preventive Health, Safety, & Nutrition training course and submission of completion certificate

Exit interview conducted with Ms. Sara Balla, Licensee Applicant.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
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: BALLA, SARA
FACILITY NUMBER: 444416379
VISIT DATE: 07/29/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 07/29/2019):

The applicant stated that she will not be providing transportation or off site field trips at this time and understands the following: written approval shall be obtained from parents if transportation is provided, children may not be left alone and shall be supervised at all times when being transported, seat belt and car seat laws must be obeyed at all times, and the applicant is responsible for ensuring that the vehicle used to transport children is safe and maintained regularly.

LPA and the applicant discussed capacity options and the applicant understands the terms of the Family Home Child Care license are as follows:

MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

The applicant understands the requirement to be present in the facility for at least 80% of operating days and hours. LPA and the applicant discussed in detail prior experience and knowledge regarding licensed child care settings. The applicant stated she will be using talking and redirection as forms of discipline. LPA informed the applicant that time out can only be used one minute per year of age. The applicant stated she understands that children's personal rights should not be violated; including no corporal punishment. LPA and the applicant discussed isolation of sick children, supervision of children, requirements for reporting suspected child abuse, unusual incident/injury reporting, heat related illnesses and weather conditions, requirements for assistant/substitute, and immunization requirements for staff including the new regulation regarding Pertussis, Measles, and Influenza. LPA informed the applicant that fire/disaster drills must be practiced at least once every 6 months, must be documented, and must be available for review by the department. LPA discussed the requirements of AB 633, recent updates to the car seat law, healthy beverages in child care, and safe sleep for infants.

LPA and the applicant discussed emergency disaster procedures including supplies in the home, lock down procedures, as well as protocols and supplies in the event of having to leave the facility. LPA and the applicant discussed methods of payment of licensing fees and updating facility information.

A review of records during today's inspection indicates that individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also 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.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #4 - REPORT DATED 07/29/2019):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
LIC809 (FAS) - (06/04)
Page: 3 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: BALLA, SARA
FACILITY NUMBER: 444416379
VISIT DATE: 07/29/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/29/2019):

The kitchen was observed to have functional appliances. The applicant stated that she will be serving snacks to children and plans on creating a menu to inform parents of what foods may be served at the facility at any given time. The kitchen used will the downstairs kitchen located in an on-limits area. The applicant understands that food allergies and dietary restrictions shall be followed and outlined in children's files.

There are stairs in the home secured with barricade gates. There is a body of water on the premises. There is a jacuzzi hot tub located, in the off-limits back yard area that is secured with latch ties and a weight bearing cover. LPA and the applicant discussed ensuring this area is secured and inaccessible at all times during days and hours of operation.

There are no firearms in the home. The Licensee does have pets in the home / animals on the premises. LPA and the Licensee discussed children's safety at all times and parent notification of activities / exposure. The applicant stated that she understands the regulations outlined in section 102417 Operation of a Family Child Care Home as it relates to firearms, bodies of water, fireplaces or open heats, and other items that can pose a risk to children's health and safety.

The indoor activity areas were observed to be organized and the applicant has age appropriate toys and supplies. The applicant stated that children will nap in the living room or the main activity room. The applicant stated that she understands that she would be required to have age appropriate equipment for infants should they need it. The applicant stated that she understands which items are required to be posted during facility operation; which are the License to operate, Emergency Disaster Plan, Facility Sketch, and Notification of Parents Rights.

The applicant does intend on assisting children with medications at this time. LPA and the applicant discussed the facility Incidental Medical Services Plan in detail. The applicant stated that she will submit the facility IMS to the Community Care Licensing Office as soon as available. LPA provided the applicant with IMS resources to produce an IMS plan if needed.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 07/29/2019):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4