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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416350
Report Date: 06/20/2024
Date Signed: 06/21/2024 04:37:22 PM

Document Has Been Signed on 06/21/2024 04:37 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SINGH, PALLAVIFACILITY NUMBER:
434416350
ADMINISTRATOR/
DIRECTOR:		SINGH, PALLAVIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 264-6788
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
06/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Pallavi SinghTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst(LPA) Anna Morales conducted an ANNUAL RANDOM visit and was greeted by Licensee Pallavi Singh and three staff. Also present were 11 children: three infants over 12 months, and eight children between the ages of 2-7 years of age. LPA observed a current children roster. Last disaster drill was conducted on 4/24/2024.

Days and hours of operation are Monday - Friday from 8:45am- 6:00pm. The licensee is the only Adult residing in the home and she has a Criminal Background Check Clearance, signed Criminal Record Statement LIC508 on file with Licensing Office.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. The home is clean, orderly, and safe for the day care children. The facility is a single story home. LPA observed the main area of the home for the day care are the two rooms. There are two bedrooms that are used for napping. There is one bathroom in the hallway for the children's use. There are two bedrooms, one bathroom and kitchen that are off limits. The children have access to the backyard. The Licensee 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 a fully charged fire extinguisher, smoke/carbon monoxide detectors, fenced backyard, and no bodies of water. Licensee stated that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are inaccessible to children.
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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: SINGH, PALLAVI
FACILITY NUMBER: 434416350
VISIT DATE: 06/20/2024
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Incidental Medical services (IMS) policy was discussed. LPA reviewed storage of medication and equipment/supplies and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417 and 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)/ (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 licensee 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 Licensee Pallavi Singh 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. LPA discussed with Licensee that Sleep Sacks are not permitted for the infants while in care.

Supervision of children was discussed with licensee, and she understands that she must be present in the home during day care hours and ensure that the children are always supervised. Licensee understands her capacity options and she understand that she cannot have more than 14 children in the home at any time. Licensee understands if she transports children via vehicle, children cannot be left in parked vehicles unattended at any time.

All food is provided by the Licensee. Licensee understands that any food brought from home shall be labeled with each child's name and properly stored. Staff stated has a first aid kit in the day care. Staff stated that nobody smokes, and she understands that smoking is prohibited in the day care.

LPA reviewed a random selection of children's file and observed that parent's rights forms, immunization records forms, consents for emergency medical treatment forms, and Identification forms are in each file. LPA observed that Staff was conducting the 15 minutes sleep log for the three infants.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SINGH, PALLAVI
FACILITY NUMBER: 434416350
VISIT DATE: 06/20/2024
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Licensee and Staff files were reviewed for the following records: Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). Staff have current Mandated Reporter Training and Pediatric CPR/FIRST AID.

LPA encouraged the Licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates. The Licensee can also email at childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list for the updates.

LPA discussed the requirements of AB 633 with the Licensee and understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations and advised that 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.

The licensee 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.

Exit interview conducted and report was reviewed with the licensee. During the exit interview, the LICENSEE, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

No citations were issued at today's visit. Exit interview was conducted with Licensee Pallavi Singh.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
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