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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416221
Report Date: 10/05/2021
Date Signed: 10/12/2021 11:50:04 AM

Document Has Been Signed on 10/12/2021 11:50 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:DAWRA, JYOTIFACILITY NUMBER:
434416221
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
10/05/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Jyoti Dawra TIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Elizabeth Larios conducted an unannounced Case Management- Licensee Initiated inspection. The purpose of this inspection was Licensee requested to increase the capacity of her Family Child Care Home (FCCH) from 8 to 14 children. Licensee was licensed on 10/16/2019, but has over a year of experience that is required to apply for an increase to a Large FCCH. Present during the inspection were Licensee, her staff Sangreeta Nayak, who helps with the day care, and five children.

A Fire Clearance as required to obtain a Large Family Child Care Home License was granted on 09/08/2021. Licensee has current Pediatric First Aid and CPR certification, which expires August 2023.

Licensee and her staff Sangreeta Nayak were present to ensure the supervision of day care children. LPA inspected the home. A fully charged fire extinguisher, and carbon monoxide and smoke detectors were observed.

LPA discussed with Licensee about the maximum capacity requirement of a Large Family Child Care Home License. The maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home shall be either:
(1) 12 children, no more than four of whom may be infants; or
(2) more than 12 and up to 14 children if at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age and there are no more than three infants being cared for during any time when more than 12 children are being cared for.

REPORT CONTINUED ON FOLLOWING PAGE #2 - REPORT DATED 10/05/2021
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAWRA, JYOTI
FACILITY NUMBER: 434416221
VISIT DATE: 10/05/2021
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 10/05/2021)
When Licensee have more than 12 and up to 14 children in the home, Licensee must notify the parent using the form LIC9150 “Parent Notification Additional Children in Care." LPA reminded Licensee that when Licensee does not have a Helper, Licensee can only care for up to 8 children at any one time in the home.

Adults who are over the age of 18 and reside in the home are Licensee, and her spouse, Ajay Dawra.They have Criminal Record, Child Abuse Index, and TB Clearance.
LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day, up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day, up to $3000.00 per person.

No regulatory violations were observed during today's inspection.

Exit Interview was conducted, where this report was reviewed with Licensee.

Licensee was informed that upon receipt of Licensing Management's approval, a license for a Large Family Child Care Home will be granted and issued to Licensee.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
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