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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416345
Report Date: 12/28/2021
Date Signed: 12/28/2021 12:43:04 PM

Document Has Been Signed on 12/28/2021 12:43 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BANSAL, NEHAFACILITY NUMBER:
434416345
ADMINISTRATOR:BANSAL, NEHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 236-9264
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/28/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Neha BansalTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Anna Morales and Aman Sharma conducted an announced pre-licensing with Applicant Neha Bansal. She currently is licensed at facility number 434416082 and she is relocating to 794 Ridge Road, Santa Clara. Fire Clearance was granted on 11/22/2021. Days and hours of operation will be Monday to Friday 6am to 11:55pm. Neha informed LPA's that she and her husband Rahul Bansal are the only adults residing during today's inspection. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's visit.

Neha Bansal has completed the Preventative Health Practices course on 11/12/2021. Pediatric First Aid & CPR on 10/16/2021 and Mandated Reporter Training on 09/09/20. Proof of completion for these certifications are on file. Copies of immunization records are also on file for the Applicant. She and her husband are the property owners and a copy of the grant deed is on file. She stated that she does not have liability insurance and understands that if liability insurance is not carried, she will have the parents complete the Affidavit Regarding Liability Insurance
(LIC 9182). She stated that she does not transport children, but understands that children cannot be left in parked vehicles unattended at any time.

The facility is a single story home. LPA's observed the main area of the home to be used for the day care will be in the living room ,one bedroom and an activity room and one bathroom. There is a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness. LPA's observed no wall heaters. LPA's observed a barricaded fire place in the living room LPA's observed the home is clean and orderly. Off limit areas inside the home: master bedroom , bedroom number 2 and 4, one bathroom and the kitchen.

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SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2021
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: BANSAL, NEHA
FACILITY NUMBER: 434416345
VISIT DATE: 12/28/2021
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Applicant stated that she will have the parents sign in/out in the entry of the house.. LPA's observed the home has working smoke/carbon monoxide detectors.

Applicant states that she does not smoke and understands that smoking is prohibited during day care hours and states that she does not have any baby walkers/inclined sleepers in the home and understands that baby walkers/inclined sleepers are not allowed in the day care. LPA's did not observed any baby bouncers, jumpers, saucer chairs, and trampoline in the home and was advised that they are not allowed in the day care.

LPA's observed the kitchen which is not accessible to the children. There are no sharp utensils, lighter/matches or open bottles of alcohol accessible to children. Child Care locks have been placed on the lower cabinets and drawers. Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled wit h the child(ren) name and properly stored or refrigerated. LPA's observed a fully charged 3A-40 BC fire extinguisher.

LPA's observed the bedrooms/activity rooms with appropriate table/ chairs, appropriate age activities, and storage area for children's personal belongings.

All of the detergents or cleaning compounds, sharps, medicines or other items which could pose a danger if readily available to children were stored where they are inaccessible, out of reach of children. LPA's reminded Applicant that poisons need to be locked up. No bodies of water observed. Applicant states that there are no firearms in the home. LPA's observed a first aid kit in the home, which also has a thermometer and sufficient emergency supplies.



Forms of discipline used by Applicant: redirecting and talking. She understands that children's personal rights should not be violated, including no corporal punishment. Supervision of children, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, lead poisoning prevention, and requirements for assistant/substitute were also discussed with the Applicant during today's inspection.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BANSAL, NEHA
FACILITY NUMBER: 434416345
VISIT DATE: 12/28/2021
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Applicant is encouraged to visit the Department's website at www.cdss.ca.gov (shortcut: www.ccld.ca.gov) to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of Laws, etc.

Incidental Medical Services (IMS) policy was discussed with the Applicant today and stated that she does not take care of children if they are sick. and does not plan on administering medication to the day care children at this time. 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's discussed the requirements of AB 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA's discussed "zero tolerance" related regulations with the Applicant and advised the Applicant of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. LPA's reminded the Applicant 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.

Licensure for Large Family Day Care pending on final review.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC809 (FAS) - (06/04)
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