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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416221
Report Date: 01/13/2025
Date Signed: 01/14/2025 08:17:24 AM

Document Has Been Signed on 01/14/2025 08:17 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:DAWRA, JYOTIFACILITY NUMBER:
434416221
ADMINISTRATOR/
DIRECTOR:		JYOTI DAWRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 636-8732
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
01/13/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Jyoti DawraTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analysts (LPAs) Mandeep Kaur and Syeda Bahar conducted a Required-3 year inspection. LPAs met with Licensees, Jyoti Dawra , and explained the reason for the inspection. Also, present in the home were 3 children and two Assistants(S1&S3). The licensees and her spouse are the only adults residing in the home.

The hours of operation are Monday through Friday 09:00AM to 5:30PM. LPAs obtained a copy of current children's roster during the inspection. Fire/disaster drill was conducted on August 16, 2024. Licensee was reminded that fire/disaster drill needs to be conducted and documented every six months. LPAs observed a fully charged 3A40BC fire extinguisher with the purchased receipt of 09/2024 and functioning smoke and carbon monoxide detectors. Licensee states that there are no weapons or firearms in the home.

LPAs toured the indoor and outdoor areas of the home with Licensee. LPAs observed that the home is clean and orderly. Cleaning products, ,sharp objects, and other items that are dangerous to children were stored inaccessible. LPAs observed sufficient age-appropriate materials, toys, and play equipment in the home. The children's bathroom is clean, sanitary, and operable. The home has a working telephone. The off limit areas are: Bedroom #3, Bedroom#4, Masterbedroom, Living room, Kitchen and Garage.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAWRA, JYOTI
FACILITY NUMBER: 434416221
VISIT DATE: 01/13/2025
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LPAs reviewed four (4) children's files during today's inspection for the following records: Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Identification and Emergency Information (LIC700), Affidavit Regarding Liability Insurance (LIC 282), and Immunization Records.

LPAs reviewed two(2) assistants files for the following records: Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), TB test, and required training. Licensees and her adult assistants have immunizations in measles, pertussis and flu. Licensee has a valid CPR/1st Aid, which expires on 08/2025. Licensee completed Mandated Reporter training certificates expire on 09/18/2025. LPAs reminded Licensee that the Mandated Reporter training and CPR/1st Aid requires renewal every two years. Licensee immunization records for TB, measles, pertussis, and influenza are also on file.

Healthy Beverage requirement were provided and discussed with Licensee.

LPAs discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also reminded 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 she registers all infant devices with the CPSC to be notified of any recalls on their purchased
equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-carecenters


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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: DAWRA, JYOTI
FACILITY NUMBER: 434416221
VISIT DATE: 01/13/2025
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Licensee 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, 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.

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/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&R's) throughout California.

No Deficiency is issued during today's inspection. Technical Violation is issued on attached page.

Exit interview conducted and report was reviewed with Licensee, Jyoti Dawra.

During the exit interview, the Licensee, Jyoti Dawra, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN FOR 30 DAYS.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025
LIC809 (FAS) - (06/04)
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