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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417022
Report Date: 02/28/2024
Date Signed: 02/29/2024 03:24:47 PM

Document Has Been Signed on 02/29/2024 03:24 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:VIDYARAMBHFACILITY NUMBER:
434417022
ADMINISTRATOR:AJANTA DASFACILITY TYPE:
830
ADDRESS:2931 EL CAMINO REALTELEPHONE:
(408) 758-8192
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 17DATE:
02/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Debanjali BanerjeeTIME COMPLETED:
05:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Anna Morales conducted an Case Management Visit and was greeted by Director Debanjali Banerjee. The purpose for this visit was in response of an Incident that occurred on 2/26/24 stating that a child had an allergic reaction after being served food containing nuts.

Director stated that they have not recorded any information this in the child's record yet due to pending more test, but staff are aware that the child had a previous reaction to the allergen.

Based on the interviews conducted a child was served food containing nuts on 2/26/24 during early dinner time. Staff interviewed stated that they were aware that the child had a possible allergy to this food and noted it on a list posted inside the child's classroom.

As a result of this investigation, a Type B deficiency was cited on the following page, LIC809 D.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

Exit Interview was conducted with the Director and APPEALS RIGHT were given.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/29/2024 03:24 PM - It Cannot Be Edited


Created By: Anna Morales On 02/28/2024 at 04:46 PM
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: VIDYARAMBH
FACILITY NUMBER: 434417022

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/08/2024
Section Cited
CCR
101223(a)(2)

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101223:Personal Rights:
(a) The licensee shall ensure that each child is accorded the following personal rights(2)To be accorded safe, healthful and comfortable accommodations,furnishings
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Director stated that she will implement a plan to to ensure that child will not be served food containing the allergen and send to CCL by the POC date.
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and equipment to meet his/her needs
This requirement was not met as evidenced by: C1 was served food containing nuts on 2/26/24 during early dinner, and staff were aware that C1 had a previous reaction to the allergen.
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024


LIC809 (FAS) - (06/04)
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