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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394501287
Report Date: 12/04/2024
Date Signed: 12/04/2024 12:38:23 PM

Document Has Been Signed on 12/04/2024 12:38 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KUMARI, PALLAVIFACILITY NUMBER:
394501287
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/04/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Pallavi KumariTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 12/04/2024, Licensing Program Analyst (LPA) Corina Beckby met with Applicant (A1) Pallavi Kumari for the purpose of a pre-licensing inspection. LPA provided the Entrance Checklist to A1 and reviewed the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Applicant and all adults living in the home have criminal background clearance and was verified by LPA accessing Guardian. A1’s tentative hours of care are Monday through Friday, from 7:30 AM until 6:30 PM. A1 does not intend on providing overnight or weekend care.



A1 owns home and proof of ownership was provided. A health and safety inspection were conducted inside and outside of the FCCH. A1 accompanied LPA for the entirety of the tour. A1 will use the attached Accessory Dwelling Unit (ADU) only for daycare purposes. The FCCH is a 2-story home with garage, kitchen living room, dining room, walk in pantry, hall closet, laundry room, loft, 4 bedrooms and 3.5 bathrooms. The ADU is one story with garage, kitchen, laundry room, living room, bathroom and 1 bedroom. The OFF-limit areas are all the garages, the main home, the laundry room in the ADU and the main backyard minus the California area. A1 understands that OFF-limit areas must remain inaccessible to children in care. A1 understands if she wants to make any OFF-limit area an ON-limit area, she must notify Licensing and LPA must do an inspection BEFORE children are allowed in said area.

Functioning smoke and carbon monoxide detectors were observed and tested. A 3A40BC fire extinguisher was observed. LPA discussed with the applicant that if there are any poisons at the home, all poisons must be locked with a key lock or combination lock. The ADU does not have stairs or a fireplace. A1 stated there are no firearms or weapons in the home.

Continued on LIC 809-C…

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KUMARI, PALLAVI
FACILITY NUMBER: 394501287
VISIT DATE: 12/04/2024
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LPA verified that toxic and hazardous items were inaccessible to children in care. The outdoor play area was toured. The ADU has a private side yard which will be accessible to the children as well as the California room in the main yard which will be accessed through the backyard of the ADU bedroom. LPA verified that the entirety of the backyard is fenced-in and walked the perimeter to ensure the safety of the fence. LPA reminded A1 if a neighbor has a body of water, to ensure the fence is secured.

LPA’s discussed Mandated Reporter Training with A1. Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their Mandated Reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English and Spanish. A1 has a current Mandated Reporter Training Certificate which will expire on 11/14/26. Current Pediatric CPR and First Aid training was verified and expires on 09/07/26. Completion of Preventative Health and Safety training including nutrition and lead exposure was verified before the inspection. Proof of required immunizations for A1.

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) or (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 discussed the Safe Sleep Regulations with A1 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 A1 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.

Continued on LIC809-C…

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KUMARI, PALLAVI
FACILITY NUMBER: 394501287
VISIT DATE: 12/04/2024
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LPA discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months. LPA provided a copy of the LIC 9227, Individual Sleeping Plan, to be completed for infants under 12 months.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. LPA discussed Water Safety Requirements and Measures and provided PIN 23-17-CCLD. A1 signed up for PIN’s at time of inspection.

A1 was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

A1 understands licenses are not 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. Type A/B citations and Immediate Civil Penalty regulation deficiencies were reviewed. LPA reminded A1 to advise the department of any and all facility closures (vacations, holidays, and illness).



A1 understands if an unusual incident occurs; Licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within 7 days to remain in compliance. A1 understands that if any structural changes are made to the FCCH; Licensing must be notified PRIOR to construction.
Continued on LIC 809-C...
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: KUMARI, PALLAVI
FACILITY NUMBER: 394501287
VISIT DATE: 12/04/2024
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A1 understands annual licensing fees are due on the anniversary of receiving license. The annual fee for a small FCCH is $73.00 per year. A late fee of $36.00 is assessed the day after the anniversary date.

A1 understands that children’s and staff records are to be maintained according to Title 22 regulations and be accessible to Licensing for up to 3 years. Records, postings, reporting requirements were reviewed. A1understands that a current roster must be maintained and that disaster drills must be conducted and documented once every six months. LPA discussed supervision, personal rights, criminal record clearances, staffing ratios and capacity, and maintaining buildings and grounds.

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.

A1 was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

On this date, 09/26/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. A1 stated she understood and is aware of all the information that was discussed and reviewed.

Effective today, 12/04/2024, Pallavi Kumari is approved for a Small Family Child Care Home license for 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. An exit interview was conducted, and the report was reviewed with Pallavi Kumari.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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