434416350-12-20-2021-07-CC-AMOS-C9QVDL-20211215152051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416350
Report Date: 12/15/2021
Date Signed: 12/20/2021 02:33:30 PM

Document Has Been Signed on 12/20/2021 02:33 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:	SINGH, PALLAVI		FACILITY NUMBER:	434416350
ADMINISTRATOR:	SINGH, PALLAVI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 264-6788
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	12/15/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Pallavi Singh		TIME COMPLETED:	10:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Anna Morales conducted an announced pre-licensing with Applicant Pallavi Singh. Days and hours of operation will be Monday to Friday 8am to 6:00PM. The Applicant informed LPA that she is the only adult residing during today's inspection. Applicant has subject to a criminal record review has obtained a criminal record and child abuse index clearances prior to today's visit. The Applicant completed the Preventative Health Practices course on 11/21/2021, Pediatric First Aid & CPR on 11/2021, and Mandated Reporter Training on 11/17/21. Proof of completion for these certifications are on file. The Applicant's copies of immunization records are also on file. The Applicant states 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). The Applicant states 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 observed the main area of the home to be used for the day care will be in the two rooms. There are two bedrooms that will be used for napping. There is on bathroom in the hallway for the children's use. *There are two bedrooms, one bathroom and kitchen that will be off limits.* The children have access to the backyard which is enclosed by a fence. Applicant stated that the playhouse in the corner of the backyard will not be used and will take the accessible ladder off. The Applicant has a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness. There are no wall heaters observed. LPA observed the home is clean and orderly. (Page 1)

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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: SINGH, PALLAVI	FACILITY NUMBER: 434416350
	VISIT DATE: 12/15/2021

NARRATIVE

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Applicant stated that she will have the parents sign in/out in the entry of the house and will take daily temperatures of the children in care. LPA observed the home has working smoke/carbon monoxide detectors. LPA observed a fully charged fire extinguisher.

The Applicant states that she does not smoke and understands that smoking is prohibited during day care hours. The Applicant 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. The Applicant states that she does not have any baby bouncers, jumpers, saucer chairs, and trampoline in the home and was advised that they are not allowed in the day care.

LPA 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. The Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated.

LPA observed the activity room with appropriate age activities. Applicant has ordered cubbies to store the children's personal belongings and they are to arrive on December 27,2021. 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 reminded Applicant that poisons need to be locked up. No bodies of water observed. The Applicant states that there are no firearms in the home. The Applicant has a first aid kit in the home, which also has a thermometer and sufficient emergency supplies. The Applicant has a working telephone.

Forms of discipline used by Applicant: redirecting and talking. The Applicant 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.

(page 2)

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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: SINGH, PALLAVI	FACILITY NUMBER: 434416350
	VISIT DATE: 12/15/2021

NARRATIVE

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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 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 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 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 and to submit the following:

1. Submit a photo of the playhouse (in the backyard) showing the ladder has been removed.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

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