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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416548
Report Date: 03/24/2023
Date Signed: 03/24/2023 11:38:09 AM

Document Has Been Signed on 03/24/2023 11:38 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KOTTARY, HARSHITHAFACILITY NUMBER:
434416548
ADMINISTRATOR:HARSHITHA KOTTARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(669) 294-1987
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/24/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Harshitha KottaryTIME COMPLETED:
11:55 AM
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On March 24, 2023 Licensing Program Analyst (LPA) Kaur met with applicant Harshitha Kottary, for an announced change of location pre-licensing inspection. The Applicant rents this single family 3- bedrooms and two bathrooms home. The home resident is applicant, her husband and their 2 children. The entire house is inspected for health and safety hazards. Days and operations are Monday โ€“ Friday from 8:30 AM โ€“ 6:00PM.

LPA and the Applicant inspected the entire home for Health and Safety Hazards. The house has 3 rooms. Daycare areas are living room 1, Living room 2, dining room, bathroom 1, bedroom 1, and backyard. Off-limit areas 2 bedrooms, kitchen and garage. Per Applicants, all toxic or dangerous chemicals are stored in a cabinet in the kitchen in the off-limit area, making them inaccessible to children. Backyard is fully barricaded. Off limit area for backyard is only - right side under fruit tree.
Fire place is barricaded by sofa.

Per Applicant, there are no firearms, weapons, or pets in the home. The isolation area for sick/ill children will be dining area. The house has multiple smoke alarms & carbon monoxide combination detectors. There are sufficient age-appropriate toys, furniture, and napping equipment in the daycare.

The Applicant stated that the facility would be providing breakfast, lunch, dinner and 2 snacks for children. LPA advised the Applicant to conduct an emergency drill once every six months and document the exercises. The Applicant was informed that NO baby walkers, exer-saucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. LPA also reminded the Applicant that smoking is prohibited at the daycare. Applicant's CPR and First Aid certifications are current and expire on 05/2023. Applicant completed Mandated Reporter Training on 02/2023.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KOTTARY, HARSHITHA
FACILITY NUMBER: 434416548
VISIT DATE: 03/24/2023
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Posting Parent's Rights and the Emergency Disaster Plan was reviewed with the Applicant during the inspection. Records to be maintained were consulted and reviewed with the Applicant. The Applicant was informed to obtain a copy of regulations and current licensing forms through the Department's website at www.ccld.ca.gov. LPA also reminded the Applicant of the Family Child Care Home License's responsibilities and Reporting requirements.The Applicant was advised to post the License when they received it.

The Applicant was informed that all adults 18 years and older living in the home, helper, or assistant must have fingerprint clearance associated with the facility. Failure to do so could result in an immediate civil penalty of $100.00 each day. LPA discussed the safe sleep regulations with the Applicant and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the Applicant 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.
T
Incidental Medical Services โ€“ IMS was discussed.. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KOTTARY, HARSHITHA
FACILITY NUMBER: 434416548
VISIT DATE: 03/24/2023
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The Applicant was informed about the Provider Information Notices (PINs) on the CCLD website and the sign-up process. The Applicant was also reminded of Mandated Reporter Online Training for Child Care Providers (AB 1207) and the additional General Training, and both are available on www.mandatedreporteca.com. The Applicant was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

Exit interview conducted and report was reviewed with the Applicant, Harshitha Kottary, and advised her that the following items need to be completed and corrected prior to approval of a Large Family Child Care Home License:

ยท Need to barricade Kitchen area.
. Review and approval by Management.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC809 (FAS) - (06/04)
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