013419864-8-21-2023-52-CC-AWRT-CUWUDP-20230821152951

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419864
Report Date: 08/21/2023
Date Signed: 08/21/2023 03:29:56 PM

Document Has Been Signed on 08/21/2023 03:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	KULKARNI, POORNIMA		FACILITY NUMBER:	013419864
ADMINISTRATOR:	KULKARNI, POORNIMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 797-7325
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 6	DATE:	08/21/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Poornima Kulkarni		TIME COMPLETED:	03:30 PM

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	On August 21st, 2023 @ 1:15pm, Licensing Program Analyst (LPA) April Wright met with licensee Poornima Kulkarni for an Unannounced Annual 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the home by the licensee. Present today were six (6) children and fingerprint cleared assistant Ratnaprabha Patil. LPA toured the home to conduct a health and safety inspection. Hours of operation are 8:30am - 6:00pm Monday through Friday. The 2 story home consists on four (4) bedrooms, three (3) bathrooms, Living Room, Family Room (day-care) kitchen, Sun room, Backyard, side yard and Garage. The home was neat and orderly, with heating and ventilation for safety and comfort of children in care. The isolation area for sick children is the sun room which is a section away from other children in care. On limit areas include: Living/Family Rooms (Daycare areas) Dining room area, downstairs bathroom (right of entry way), sun room and backyard. Off-limits areas include: Entire second level of home including all bedrooms, side yard, kitchen and garage. The off limits area and will be made inaccessible by closed and/or locked doors, gates and visual supervision. There is a gate present at the bottom of the stairs to prevent access to the upper level of the home. There are no pools, hot tubs or any other bodies of water present in the home. LPA did not observe any hazardous materials or toxins accessible to children. There are age appropriate toys that appear to be safe and in good condition. Per licensee, there are no weapons or firearms present in the home. See LIC809 -C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KULKARNI, POORNIMA	FACILITY NUMBER: 013419864
	VISIT DATE: 08/21/2023

NARRATIVE

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The home has a fully charged 210ABC fire extinguisher located in kitchen/dining area, working smoke and carbon monoxide detector, mobile /landline telephone. There is a fireplace with glass in the day-care room that is locked, blocked with a table and inaccessible to children in care. Per licensee there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers.

LPA requested and reviewed the files of six (6) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was reviewed and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 4/3/2023. The licensee has a current CPR/First aid certificate which expires on 7/22/2025 and Mandated Reporter training was completed on 4/17/2023. The licensee is in ratio today. All required forms are posted and visible for public review.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP . 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: https://www.ada.gov/resources/child-care-centers/.

See LIC 809C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KULKARNI, POORNIMA	FACILITY NUMBER: 013419864
	VISIT DATE: 08/21/2023

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Kulkarini confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Poornima Kulkarini.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

LIC809 (FAS) - (06/04)

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