434416548-4-15-2024-07-CC-MKAR-D4CQA6-20240415115926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416548
Report Date: 04/15/2024
Date Signed: 04/15/2024 11:59:54 AM

Document Has Been Signed on 04/15/2024 11:59 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	KOTTARY, HARSHITHA		FACILITY NUMBER:	434416548
ADMINISTRATOR/ DIRECTOR:	HARSHITHA KOTTARY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 294-1987
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 1	DATE:	04/15/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	Harshitha Kottary		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

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), Mandeep Kaur conducted an unannounced annual inspection. LPA met with Licensee Harshitha Kottary and explained the reason for the inspection. Present during today's inspection were Licensee, one child , and an assistant, Reehana Shaik. The hours of operation are Monday through Friday 08:30AM to 6PM. There is a board to post required postings, such as license and notification of parent's rights. LPA toured the inside and outside of the home with Licensee. The off-limits areas inside are two bedrooms, kitchen and garage. Disinfectant and cleaning supplies were inaccessible to children. LPA reminded licensee that anything sharp or states to keep out of reach of children, such as blades or razors need to be inaccessible. There are age appropriate toys and equipment for children inside and outside of the home. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 12/18/2023. Licensee stated that there are no weapons, such as firearm, stored in the home. The backyard is used for the play. Licensee stated that provides morning fruits, morning snacks, lunch, early dinner and evening snacks to the children. LPA discussed the beverages requirements provided by the providers to the children. -----------------CONTINUES ON 809 DATED 04/15/2024 PAGE 2-----------------

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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: KOTTARY, HARSHITHA	FACILITY NUMBER: 434416548
	VISIT DATE: 04/15/2024

NARRATIVE

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--------------CONTINUATION OF 809 DATED 04/15/2024 PAGE 1-------------

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 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 also discussed that either licensee or an assistant needs to be present in the infant nap room during an infant is taking a nap.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters.

A copy of the children roster was obtained. Five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and notification of parent's rights. LPA also reviewed sleep log. Licensee was advised that an individual infant sleeping plan (LIC 9227) shall be completed for each infant up to 12 month of age, the provider has in care and maintained at the facility in the infant's file.

LPA reviewed 2 staff files. Statement Acknowledging Requirement to Report Child Abuse,TB Clearance and Immunizations (Measles, Pertussis, and Influenza) and required training. LPA reminded Licensee that the Mandated Reporter Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

Licensee completed the Mandated Reporter training on 02/08/2023. Licensee has a valid CPR/1st Aid, which
expires on 07/2025.

----------------CONTINUES ON 809 DATED 04/15/2024 PAGE 3----------------

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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: KOTTARY, HARSHITHA	FACILITY NUMBER: 434416548
	VISIT DATE: 04/15/2024

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--------------CONTINUATION OF 809 DATED 04/15/2024 PAGE 2-------------

The adults 18 and over living in the home are Licensee and her husband. All adults have cleared criminal record and child abuse index. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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

During the exit interview, the Licensee, Harshitha Kottary, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

As a result of this inspection, Type B citations were issued and Technical advisory was provided.
Exit interview conducted and report was reviewed with Licensee, Harshitha Kottary. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/15/2024 11:59 AM - It Cannot Be Edited

Created By: Mandeep Kaur On 04/15/2024 at 11:19 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KOTTARY, HARSHITHA	FACILITY NUMBER: 434416548
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above for 1 of the staff ( #1) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/29/2024
	Plan of Correction
1 2 3 4	By Poc, by 04/29/2024, the licensee will submit the certificate of completion of the Mandatory Reporter Training (AB1207).

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above for one of the child (C5) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/29/2024
	Plan of Correction
1 2 3 4	By Poc, by 04/29/2024, the licensee will submit An Individual Sleeping Plan (LIC 9227) for C5.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Belinda Devall

LICENSING EVALUATOR NAME:

Mandeep Kaur

LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

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