013422890-8-21-2023-52-CC-RHAR-CUWUVF-20230821155503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422890
Report Date: 08/21/2023
Date Signed: 08/21/2023 03:55:09 PM

Document Has Been Signed on 08/21/2023 03:55 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:	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: 6	CENSUS: 6	DATE:	08/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:28 PM
MET WITH:	Vijaya Kotpalliwar		TIME COMPLETED:	04:05 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 21, 2023 at approximately 1:30pm Licensing Program Analyst (LPA) Russ Haderer met with licensee Vijaya Kotpalliwar for the purpose of conducting an unannounced annual inspection. Living in the home is the licensee, her fingerprint and TB cleared husband, and their two children 18 year old adult daughter and 14 year-old son. Present today was the licensee, her helper, her husband, daughter and 6 children in care (4 infants; 2 two years old), the home is in ratio today. The hours of operation will remain Monday-Friday, 8:30 AM to 6:00PM. 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 small office and detached 2-car garage. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There is a new shed built in the back yard that has a locked door to prevent access by children. Per the licensee there are no firearms in the home. 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 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. 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. There is a screened fireplace in the off limits living room. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 4/12/2023. All required licensing documents are framed and posted and visible for public review.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
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: KOTPALLIWAR, VIJAYA	FACILITY NUMBER: 013422890
	VISIT DATE: 08/21/2023

NARRATIVE

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On-limit-areas include: Foyer/Entry area; Office, Bedroom 3 (Day care area); Jack and Jill bathroom attached to laundry room; Laundry room; Family room; and 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 2-car garage; gated right and left side yards; locked shed in the backyard area. Off limit areas are inaccessible by closed and/or locked doors and visual supervision.

Children's files were reviewed and found to be complete and in good order. The facility roster was reviewed, and a copy obtained. Infant sleep logs are available and kept in good detail. Infant Safe Sleep Plans were completed, signed, and dated. Licensee carries childcare liability Insurance through Markel Insurance Company, the policy is in effect through 11/18/2023. The Licensee’s Health and Safety training is completed, pediatric CPR/First Aid certificate is current and expires on 6/17/2025. Licensee has proof of required immunizations, and mandated reporter (verified AB1207), expires on 09/15/2023. The licensee is in compliance with the immunization laws which pertains to day care providers.

LPA reminded the licensee of the following; Mandated Reporter certificate and CPR/First Aid certificate must be 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 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/.

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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
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: KOTPALLIWAR, VIJAYA	FACILITY NUMBER: 013422890
	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 at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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, licensee Vijaya confirmed there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

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

Exit interview conducted and report was reviewed with the licensee Vijaya Kotpalliwar.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
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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