013422890-9-22-2021-52-CC-RHAR-C74NXP-20210922105128

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422890
Report Date: 09/22/2021
Date Signed: 09/22/2021 10:51:37 AM

Document Has Been Signed on 09/22/2021 10:51 AM - It Cannot Be Edited

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:	KOTPALLIWAR, VIJAYA		FACILITY NUMBER:	013422890
ADMINISTRATOR:	KOTPALLIWAR, VIJAYA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 579-4399
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	09/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Vijaya Kotpalliwar		TIME COMPLETED:	10:55 AM

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On September 22, 2021 at approximately 8:15am Licensing Program Analyst (LPA) Russ Haderer met with licensee Vijaya Kotpalliwar for the purpose of conducting an unannounced annual inspection. Present for today’s inspection was licensee’s fingerprint and TB cleared husband, their 12 year old son (virtual learning) and no children in care. During the inspection, 4 children arrived (2 infants and 2 toddlers). The hours of operation will remain Monday-Friday, 8:30 AM to 6:00PM.

On-limit-areas include: Foyer/Entry area; Office, Bedroom 3 (Day care area); Jack and Jill bathroom attached to new laundry room; Laundry room, Family room; backyard. Licensee reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products and laundry soaps. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

Off-limit-areas include: 3 bedrooms (including the master bedroom w/bathroom), living room, Kitchen, dining room, main house bathroom, hallway for bedrooms, detached garage, gated right and left side yards. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. Licensee is aware she must contact licensing so that an inspection can be completed prior to changing an off limits area to on limits.

The facility is a single story 3 bedroom, 2 bathroom home with a laundry room, kitchen, living room, study/office, daycare area, entryway/foyer with an additional office. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Per the licensee, the ISOLATION AREA will be in the office area attached to the foyer where licensee can see and monitor the child away from the other children in care.

The home is neat and clean, with heating and ventilation for safety and comfort. The outdoor play area is fenced, and is free from defects and dangerous conditions. There were ample age appropriate toys that were observed to be safe and in good condition. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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: KOTPALLIWAR, VIJAYA	FACILITY NUMBER: 013422890
	VISIT DATE: 09/22/2021

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There is a fully charged 3A40BC fire extinguisher mounted in the day care area, working (tested) carbon monoxide and smoke detectors, telephone, and a first aid kit. The fireplace is in the off limits living room and is screened. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 7/15/2021. All required licensing documents are framed and posted and visible for public review.

At 10:00am, children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Liability Insurance is purchased through Westchester DCI. The Licensee’s Health and Safety training is completed, pediatric CPR/First Aid certificate is current and expires 05/15/2023. Licensee has proof of required immunization's, and mandated reporter (verified AB1207), expires on 09/15/2023. LPA reminded the licensee of the following; Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care 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

Licensee 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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: KOTPALLIWAR, VIJAYA	FACILITY NUMBER: 013422890
	VISIT DATE: 09/22/2021

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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.

There were no deficiencies issued during today’s inspection: This report will remain on file for 3 years.

A review of operating safely during the Covid-19 pandemic (RAST) was conducted.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Vajaya Kotpalliwar. LPA left the home at 11:00 am.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC809 (FAS) - (06/04)

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