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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700337
Report Date: 06/17/2025
Date Signed: 06/17/2025 04:25:47 PM

Document Has Been Signed on 06/17/2025 04:25 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ARA, ROSHANFACILITY NUMBER:
435700337
ADMINISTRATOR/
DIRECTOR:		ARA, ROSHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 464-1659
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Assistant Provider Jnaneswari SarampatiTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On 6/17/2025 at 2:30 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Random Visit. LPA met with the Assistant Provider Jnaneswari Sarampati and explained the nature of site visit. Present on this visit were another Assistant Provider Deepa Malik, 1 infant children and 9 preschool children. The home operates from Monday to Friday 8:30am to 6pm.

LPA toured the home to conduct a Health and Safety Inspection with the Assistant Provider. The home is a single-story home with 4 bedroom and 2 bathrooms. The home is neat and clean with central heating and ventilation for safety and comfort.

The ON-LIMIT AREAS are the family room (next to the garage), sun room, and the master bedroom (music room) and master bathroom and the backyard.

The OFF-LIMIT AREAS are the living room, dining area, kitchen, hallway bathroom, bedroom number 1, 2, 3 and the garage will be inaccessible to children by locked doors, safety gates and visual supervision. There is a safety gates located in the home to prevent access to the OFF-LIMIT AREAS. The home does have a fireplace that is screened to prevent access by children.

The designated isolation area is the living room. The backyard is the designated outdoor play area that is fully fenced. The outdoor area has age-appropriate toys that appear to be clean and free from defects and dangerous conditions. There are no pools, hot tubes or any other bodies of water. All hazardous materials and toxins are kept out of reach from children and are not accessible. The home has a fully charged fire extinguisher 3A40BC, working smoke detector, carbon monoxide, mobile phone and fully stocked first aid kit.

NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Manel Estoesta
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/17/2025 04:25 PM - It Cannot Be Edited


Created By: Manel Estoesta On 06/17/2025 at 03:31 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ARA, ROSHAN
FACILITY NUMBER: 435700337

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)


This requirement is not met as evidenced by: 102416.1 (a) Personnel Records. All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.



Deficient Practice Statement
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Based on, at 3pm, during the LPA's record review, that S1 and S2 personnel records was not maintained in the facility. S1 was not able to present any personnel records to LPA during the visit. The licensee did not comply with the section cited above which poses a potential health, safety and personal rights risk to children in care.
POC Due Date: 07/01/2025
Plan of Correction
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LPA discussed to S1 to develop a Plan of Correction. The Plan will describe how the licensee will bring their home into compliance. It must be measurable andverifiable. LPA provided copies of LIC 126, LIC 311 D, and Family Child Care Home Provider Requirements and Family Child Care Home Capacity Requirements Flyers.

The Licensee will provide copies of S1 and S2 personnel record to LPA via email or mail on or before the set due date.
Type B
Section Cited
CCR
102359(a)


This requirement is not met as evidenced by: 102359 (a) Advertisements and License Number. Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.
Deficient Practice Statement
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Based on, at 2:30 pm, LPA observed a Licensee's advertisement poster, posted on the side yard gate without the Licensee's License number. This was also observed during the LPA's visit on 6/28/203. LPA also reviewed the Licensee's website and the license number was not in any part of the website. The licensee did not comply with the section cited above which poses a potential health, safety and personal rights risk to children in care.
POC Due Date: 07/01/2025
Plan of Correction
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LPA discussed to S1 to develop a Plan of Correction. The Plan will describe how the licensee will bring their home into compliance. It must be measurable and verifiable.

The Licensee with include the License number on the advertisement and will send proof to LPA via email or mail on or before the due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Jason Jang
NAME OF LICENSING PROGRAM MANAGER:
Manel Estoesta
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ARA, ROSHAN
FACILITY NUMBER: 435700337
VISIT DATE: 06/17/2025
NARRATIVE
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There are no firearms or weapons on the premises. The Licensee conducted and documented fire and disaster drills, and the last one conducted on 4/7/25. The Licensee owns the home and the child care liability insurance policy with Acord expired 2/2/24.

The Assistant Provider Jnaneswari Sarampati CPR and First Aid certificate expires in August 2027. The Licensee’s CPR and First Aid certificate expired on 6/10/2025. The Licensee’s Mandated Reporter Training was taken on 7/12/2024.

Facility roster of children was reviewed, and a copy was obtained. Children’s files were reviewed, which included records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Napping Log and Immunization. The licensee is in ratio today. The facility does not transport children currently. Licensee has a current and valid Driver License. Licensee understands that children cannot be left in parked vehicles unattended at any time.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

LPA discussed the safe sleep regulations 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 the Assistant Provider 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Manel Estoesta
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ARA, ROSHAN
FACILITY NUMBER: 435700337
VISIT DATE: 06/17/2025
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

LPA Estoesta informed the Assistant Provider Jnaneswari Sarampati, that this report dated 6/17/2025 with a Type B citation which maybe be posted for 30 consecutive days as there is a potential risk to the health, safety, or personal rights of children in care.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Assistant Provider Jnaneswari Sarampati.

NAME OF LICENSING PROGRAM MANAGER: Jason Jang
NAME OF LICENSING PROGRAM ANALYST: Manel Estoesta
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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