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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416546
Report Date: 07/10/2024
Date Signed: 07/10/2024 04:15:51 PM

Document Has Been Signed on 07/10/2024 04:15 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:DEVRAY, ANITAFACILITY NUMBER:
434416546
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
07/10/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:07 PM
MET WITH:Anita DevrayTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Mandeep Kaur conducted an unannounced Case Management- Licensee Initiated inspection with Anita Devray, Licensee. The purpose of today's inspection: address the Application for a Large Family Child Care Home license (Capacity Change) that the Licensee submitted to the Department on February 26, 2024. Licensee is currently licensed for Small Family Child Care Home (FCCH). Licensee has been licensed since 03/23/2023; therefore, she has at least one year of experience as a family child care provider to apply for a Large FCCH. A fire Clearance for Large Family Child Care Home was granted on 05/21/2024.

LPA observed that 6 children were present in the home during today’s inspection. Also present during today's inspection, licensee's husband, Sharad Jadham. Licensee stated that she, her husband and two minor children are residing in the home. Days and hours of operation are Monday to Friday from 08:00 AM to 6:00 PM. The Licensee completed the Preventative Health and Safety Child Care Training on 01/10/2023 and a copy of the certification is on file. The Licensee has proof of Pediatric CPR and First Aid training on 01/12/23 on file. A copy of current TB test, flu, MMR, and Tdap vaccinations for the Licensee are on file. Proof of completion of the Mandated Reporter Training for Child Care Providers (completed on 01/11/23) is on file. The Licensee owns the home and Tax Bill verifying control of property is on file. Licensee does not plan on obtaining liability insurance for the day care. Licensee understands that parents will need to fill out the Affidavit Regarding Liability Insurance (LIC 282) if she does not plan on obtaining liability insurance for the day care. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's inspection.

The Licensee agreed to give LPA a tour of the home (indoor/outdoor) during today's inspection.

LPA reviewed six (6) 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.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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: DEVRAY, ANITA
FACILITY NUMBER: 434416546
VISIT DATE: 07/10/2024
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LPA observed the home is a single-story home with two (2) bedrooms, (2) bathrooms, living room, kitchen, garage, and backyard. There is a working telephone in the home. The home is clean and orderly, with heating and ventilation for safety & comfort.

LPA observed no fireplace and no wall heaters. The off-limit areas inside the home are: 2 bedrooms, one bathroom, kitchen and attached garage. There are safe and age-appropriate toys, play equipment, and materials for the children in the home. The Licensee has a designated area in the home (kitchen area) where a child(ren) can be isolated if exhibiting signs of illness. The home has at least 1 working smoke and carbon monoxide detector in the home. The Licensee has one fully charged fire extinguisher (2A10BC) inside the home. The Licensee states that she does not have any pets or weapons in the home. All cleaning compounds and medications are adequately stored (locked cabinets) and garage inaccessible to children. LPA reminded Licensee that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes. The Applicant has a first aid kit in the home, with sufficient emergency supplies, including a no-touch thermometer.

Kitchen tour: LPA observed the refrigerator and freezer in the home are clean. All sharp utensils and cleaning products are inaccessible to the children. The Licensee provides morning snacks, lunch and afternoon snacks to the children. The Licensee 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.

Bathroom tour: LPA observed the bathroom toilet and faucet are clean, safe, and operable. The shower is free of any hazards. All shampoos, soap, medication, mouthwash, perfumes, razors, cleaning products, air fresheners, and nail polish/remover are inaccessible to the children.

Outdoor tour: LPA observed the outdoor backyard of the home is fenced, safe, and secure for the children. There are no bodies of water in the backyard. Licensee was advised that outdoor play shall be supervised at all times.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
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: DEVRAY, ANITA
FACILITY NUMBER: 434416546
VISIT DATE: 07/10/2024
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Forms of discipline to be used by Licensee: talking to children and redirecting. The Licensee 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, heat related illnesses, and requirements for assistant/substitute were also discussed with the Licensee during today's inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see 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: https://www.ada.gov/resources/child-care-centers/.



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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA 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. LPA also informed Licensee 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.

On this date, 05/28/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
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: DEVRAY, ANITA
FACILITY NUMBER: 434416546
VISIT DATE: 07/10/2024
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LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes,
children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families
obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs)
throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and
stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other
important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information
website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child
Care option to receive email communication.

Exit interview conducted and report was reviewed with Licensee Anita Devray.

NOTICE OF SITE VISIT GIVEN AND MUST BE POSTED FOR 30 DAYS.

LPA advised Licensee that Large Family Child Care Home license will be issued upon completion of the following:

1. Licensing Program Manager (LPM) review and approval.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC809 (FAS) - (06/04)
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