434417017-2-2-2022-07-CC-PHEZ-CB9SBM-20220202124409

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417017
Report Date: 02/02/2022
Date Signed: 02/02/2022 12:44:45 PM

Document Has Been Signed on 02/02/2022 12:44 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:	SREERAM, KAVITHA		FACILITY NUMBER:	434417017
ADMINISTRATOR:	KAVITHA SREERAM		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 913-5745
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	02/02/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kavitha Sreeram		TIME COMPLETED:	01:00 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 Pietro Hernandez conducted a Scheduled Pre licensing visit and was greeted by Kavita Sreeram. Applicant has submitted an application for a large family day care for Monday through Friday, 8am-6pm, Fire Clearance was granted on 1/14/22. Applicant lives in her home with her husband Naga Mahesh Sreeram and her two adult children Pallavi Sreeram and Naga Raghay. They own the home. The Applicant informed LPA that there are no other adults or children who reside that the house during today's inspection. All individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's pre-licensing inspection. The Applicant has completed the Lead Safety training on 10/05/21. Pediatric First Aid & CPR expires on 03/14/22, She will sign up to take the class again before it expires. Mandated Reporter Training is current and is on file. Proof of completion for these certifications are on file. The Applicant's copies of immunization records are also on file. The Applicant owns the property and a copy of lease agreement is on file. The Applicant states that she will have liability insurance and understands that if liability insurance is not carried, she will have the parents complete the Affidavit Regarding Liability Insurance (LIC9182) The Applicant states that she does not transport children, but understands that children cannot be left in parked vehicles unattended at any time (1 of 4)

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2022

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: SREERAM, KAVITHA	FACILITY NUMBER: 434417017
	VISIT DATE: 02/02/2022

NARRATIVE

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Forms of discipline used by Applicant: redirecting and talking. The Applicant 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, lead poisoning prevention, and requirements for assistant/substitute were also discussed with the Applicant during today's visit

LPA went over the records that need to be maintained at the home with the Applicant. A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the Applicant. This packet contains information on documents to be made accessible to the Public and documents to be provided to Parents/Legal Guardians. Applicant is encouraged to visit the Department's website at www.cdss.ca.gov (shortcut: www.ccld.ca.gov) to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of Laws, etc.
LPA also discussed with the Applicant about the continuing requirements, which include but are not limited to the following topics: (1)Separating sick children when they show signs of illness; (2) Supervision of Children;(3)Capacity Options; (4)transportation of children; (5)Procedures for Reporting Suspected Child Abuse and Unusual Incident/Injuries; (6)Safe Sleep; and (7) Healthy Beverages in Child Care.
Incidental Medical Services (IMS) policy was discussed with the Applicant today. 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. The Applicant states that she does not plan on administering medication to the day care children at this time.

Family Child Care Home packet with updated Licensing forms, Self-Assessment Guide, “Lead Poisoning Facts Information" Flyer, and "Safe Sleep" Information was mailed to the Applicant. The Applicant was also provided a copy of the "COVID-19 Updated Guidance: Child Care Programs and Providers" published by the State of California on 7/17/2020 and "Mandatory Directive: Program Serving Children or Youth" published by Santa Clara County Public Health on 10/29/2020.
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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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: SREERAM, KAVITHA	FACILITY NUMBER: 434417017
	VISIT DATE: 02/02/2022

NARRATIVE

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LPA's reminded applicant that smoking, baby walkers, bouncers, jumpers and similar items are not allowed in family child care homes. A Family Child Care Home packet was provided to and reviewed with the applicant. LPA observed the home is exceptionally clean and orderly for the pre-licensing inspection. Off limits areas inside the home: all 4 bedrooms. Off-limits areas is the back yard are and storage shed. There is a fence surrounding the backyard.

The Applicant states that the home does not have wall heaters. LPA observed the home has working smoke/carbon monoxide detectors and a pull fire alarm.

The Applicant states that she does not smoke and understands that smoking is prohibited during day care hours. The Applicant states that she does not have any baby walkers/inclined sleepers in the home and understands that baby walkers/inclined sleepers are not allowed in the day care. Applicant stated that trampoline in the home and was advised that they are not allowed in the day care.

LPA observed the kitchen which is inaccessible to the children. There are no sharp utensils, lighter/matches or open bottles of alcohol accessible to children. The Applicant 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. LPA observed a fully charged 2A10BC fire extinguisher.

LPA observed the activity rooms with appropriate table and chairs appropriate age activities.. LPA observed mats for the children which will be disinfected daily. LPA observed a secured fenced pool BUT the fence is only 4 ft tall AND regulations require it to by a minimum or 5 ft tall.) (Back Yard is off limits however the Pool requirements are .) Licensee is aware that this will need to be corrected prior to submitting my report for management approval. Water for the facility will be provided by a water pitcher

LPA observed bathroom to have COVID posting and paper towels accessible. LPA did not observe any detergents or cleaning compounds, sharps, medicines or other items which could pose a danger if readily available to children were stored where they are inaccessible, out of reach of children. LPA reminded Applicant that poisons need to be locked up. The backyard is fenced with an emergency exit. Body of water was observed.

The Applicant states that there are no firearms in the home. The Applicant has a first aid kit in the home, which also has a thermometer and sufficient emergency supplies.
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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: SREERAM, KAVITHA	FACILITY NUMBER: 434417017
	VISIT DATE: 02/02/2022

NARRATIVE

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LPA discussed the requirements of AB 633 with the Applicant. The Applicant understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Applicant and advised the Applicant of 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. LPA reminded the Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children.

LPA also Covered Covid-19 Technical assistance during the inspection.

A large family child care home license will be granted upon manager's review. Applicant will send completed Preventative Health Practices course upon completion.

Applicant understands that she will need to repair the pool fence and bring it up to Title 22 Regulation code and have it reinspected prior to the application being presented to management for final approval.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

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