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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417067
Report Date: 01/19/2024
Date Signed: 01/19/2024 02:45:09 PM

Document Has Been Signed on 01/19/2024 02:45 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:ACHIEVERSFACILITY NUMBER:
434417067
ADMINISTRATOR:DIVYA KOHLIFACILITY TYPE:
850
ADDRESS:404 EAST EVELYN AVENUETELEPHONE:
(408) 685-2289
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 30TOTAL ENROLLED CHILDREN: 17CENSUS: 7DATE:
01/19/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Divya KohliTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Mel Matos met with Divya Kohli, Director, for an unannounced Required - 3 Year inspection. LPA toured the indoor and outdoor areas of the Facility with Divya Kohli, director, during today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. Days and hours of operation are Monday through Friday 8:00 AM to 6:00 PM. The facility is licensed to serve a maximum of thirty (30) children ages 2 to Kindergarten in Classrooms 1, 2, & 3.

LPA reviewed five children's and three staff files (1 director, 1 teacher, & 1 aide) during today's inspection. Each child's file reviewed contains all required forms/documents, including Admission Agreement, Emergency Medical Consent (LIC 627), and Information and Emergency Information form (LIC 700). All staff files reviewed contain the required forms/documents, including transcripts/verification of experience/immunization records, and Health Screening Report (LIC 503). All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Director and one aide has current CPR and First Aid certifications on file. Divya understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Last fire/disaster drill was completed on December 6, 2023.

LPAs observed that the teacher/child ratio was in compliance during today's inspection. LPA observed seven preschool children with the director and one aide during today's inspection. Divya understands the conditions, limitations, and capacity specifications of the Facility license. Divya understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area.

LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Divya states that staff and a third-party cleaning service clean the Facility in the evenings. Divya understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in each Classroom and in the outdoor playground area via reusable water bottles/filtered tap water.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ACHIEVERS
FACILITY NUMBER: 434417067
VISIT DATE: 01/19/2024
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Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom stall not utilized by the children which an isolated child can use if needed. Divya states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in each Room.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. The Facility provides AM/PM snacks and parents provide lunch for the children. Divya understands that any food brought from home needs to be labeled with each child's name and properly stored. The Facility has trash cans with tight fitting lids for solid waste in the Facility. Cleaning supplies are inaccessible to the children and stored inaccessible to children. LPA observed a complete First Aid kit in the Facility. Divya states that the Facility does not administer any medication at this time.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 playground areas utilized by children are surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade is provided by a large holly tree and building overhang in the playground area. There is sufficient resilient materials (wood chips) in the outdoor playground area. LPA did not observe any bodies of water.

Divya Kohli, Director, 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview conducted and report was reviewed with Divya Kohli, Director. No deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC809 (FAS) - (06/04)
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