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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624038
Report Date: 11/04/2021
Date Signed: 11/04/2021 02:37:12 PM

Document Has Been Signed on 11/04/2021 02:37 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:WALIA, NIHARIKAFACILITY NUMBER:
343624038
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/04/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Niharika WaliaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kelly Ferrara met with Applicant Niharika Walia to conduct an announced Pre-Licensing inspection. LPA toured the applicant's two story, four bedroom, three bathroom home. All adults living in the home have received a criminal background clearance and are associated to the facility.

Off-limit areas will consist of: Formal dining room and living room, entire upstairs and garage. Applicant stated she will have children enter through the side gate and come inside through the back entrance. Applicant understands that children may never enter the off-limit areas. Applicant acknowledges she is required to notify licensing prior to making changes to off-limit areas so that they may be inspected for safety. LPA observed a functioning smoke and carbon monoxide detector and 2A-10-BC fire extinguisher. Hazardous cleaning products and chemicals, knives, and medications are all stored inaccessible to children. Applicant understands that poisons must be locked. The backyard is fenced and LPA advised applicant that in areas that are not fenced, 100% supervision must be maintained at all times. LPA observed the pool was fenced and gated according to regulations and the spa was empty and locked. Applicant stated she does not have any firearms.

Applicant has a current pediatric CPR/1st aide certificate and has completed the preventative health and safety course. Applicant has completed the Mandated Reporter training and has provided proof of immunizations. LPA obtained proof that the applicant lives in the home. Applicant understands that if she does not have liability insurance, she will have parents fill out an affidavit.

LPA discussed current COVID-19 guidelines, postings, and protocols. LPA discussed Type A and Type B citations, Zero Tolerance, and Civil Penalties. LPA discussed open door policy, supervision, fire drills, children’s personal rights, reporting requirements, and the smoking prohibition with the applicant. A current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer in care. LPA went over requirements for an assistant.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: WALIA, NIHARIKA
FACILITY NUMBER: 343624038
VISIT DATE: 11/04/2021
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Annual fees must be paid promptly and by the due date or late fees will be assessed. Applicant understands that the license is non-transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected. LPA explained to applicant that she has the option to put her home on Inactive Status at any time for up to a year while continuing to pay fees.

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.

LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the applicant can request to be added to the distribution list to receive Quarterly Updates. LPA provided form LIC 311D and discussed the required forms for children's records, employee records, and forms required to be kept on file at the facility. LPA provided the Licensing Agency website (WWW.CCLD.CA.GOV), so that the applicant may obtain updated licensing information, regulations, PINs, and forms.

As of today, November 4th, 2021, applicant is licensed as a Small Family Child Care Home with a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.
SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
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