434416836-9-6-2023-07-CC-SYIP-CVESDY-20230906134754

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416836
Report Date: 09/06/2023
Date Signed: 09/06/2023 01:47:59 PM

Document Has Been Signed on 09/06/2023 01:47 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:	SHIRVANTE, DIVYA		FACILITY NUMBER:	434416836
ADMINISTRATOR:	DIVYA, SHIRVANTE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(669) 265-7546
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Divya Shirvante		TIME COMPLETED:	11:40 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) Samantha Yip conducted an announced pre-licensing inspection. LPA met with Application Divya Shirvante and explained the reason for the inspection. The purpose of this inspection is Applicant applied for a change of location. Applicant is currently licensed at 1650 Lederer Circle, San Jose 95131; facility number #434416500. A fire clearance was granted on 08/17/2023. The hours of operation are Sunday to Saturday 8:30AM to 5:30PM. Applicant will be using her cell phone. LPA toured the inside and outside of the home with Applicant. The off-limit areas of the home are the entire upstairs, patio on the second floor, and the garage. There are stairs in the home, which are barricaded. The home was observed to be clean. There are toys and equipment for children. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible to children. LPA discussed with Applicant about placing a latch on the door to the water heater. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Applicant stated that there are no weapons, such as firearms, stored on the premise. Applicant does not plan on transporting children, but understands that children cannot be left alone and unattended in parked vehicles. Applicant plans on providing all meals and snacks to children. Applicant understands that all food brought from home needs to have the child's name on it. The backyard is used and is fenced. LPA observed that there are panels on the left side of the yard that are loose causing there to be gaps in the fence. Applicant placed a gate to barricade the fence until the panels can be fixed. She send a picture of the fence. There is plastic play structure in the backyard. LPA discussed with Applicant about ensuring the rope on the structure is secured. There were no bodies of water observed during today's inspection. --------------------continues on 809 dated 09/06/2023 page 2---------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SHIRVANTE, DIVYA	FACILITY NUMBER: 434416836
	VISIT DATE: 09/06/2023

NARRATIVE

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--------------------continuation of 809 dated 09/06/2023 page 1--------------------
LPA discussed the safe sleep regulations with applicant 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 [applicant, licensee, or facility representative] 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 Applicant about ensuring that all sheets in the crib or pack and play are tight fitted.

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) or (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.

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

LPA reviewed with applicant 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.
Applicant has a valid CPR/1st Aid, which expires on 02/2024. Applicant completed the Mandated Reporter training on 04/28/2022. Applicant was reminded that Mandated Reporter training requires renewal every two years. Applicant's Preventive Health and Safety training and immunization records for measles, pertussis, and decline of influenza are on file. A copy of the her certificate for training on Lead Poisoning Prevention was obtained during today's inspection.
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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SHIRVANTE, DIVYA	FACILITY NUMBER: 434416836
	VISIT DATE: 09/06/2023

NARRATIVE

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-------------------continuation of 809 dated 09/06/2023 page 2------------------

The adults 18 and over living in the home are Applicant and her spouse. Applicant also has one minor child. Applicant 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, 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.

On this date, 09/06/2023, 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.

Applicant was informed of the MyChildCarePlan.org site, 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.

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 the applicant, Divya Shirvante. A license for a large Family Child Care Home (FCCH) will be granted and issued upon approval of Licensing Program Manager.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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