<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422894
Report Date: 08/06/2021
Date Signed: 08/06/2021 11:27:51 AM

Document Has Been Signed on 08/06/2021 11:27 AM - 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:RAIKAR, KIRANFACILITY NUMBER:
013422894
ADMINISTRATOR:RAIKAR, KIRANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 203-0214
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 11DATE:
08/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Kiran RaikarTIME COMPLETED:
11:45 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
On August 6, 2021 at approximately 9:45 AM Licensing Program Analyst (LPA) Lorraine Dacanay Breaux met with licensee Kiran Raikar for the purpose of conducting an unannounced Annual Required inspection for Health and Safety compliance. Present for the inspection were 2 (two) her fingerprint and TB cleared staff and 11 children in care.
Hours of operation Monday -Friday 8:30 am to 5:00pm.

The facility is a two story home consisting of a kitchen, living room, family room, one master bedroom with bathroom, two additional bedrooms, loft and an attached 2-car garage and an enclosed/fenced private backyard. The home is neat and clean, with heating and ventilation for safety and comfort. LPA did not observe any hazardous materials or toxins accessible to children today. The facility had a working smoke detector, carbon monoxide detector, working telephone and fully charged A10BC fire extinguisher. Per licensee, there are no firearms in the home. No bodies of water such as pools or hot tubs were accessible to children. Poisons, detergents, and medication were also inaccessible. The fireplace is screened off.

ON LIMITS area includes the living room, one bedroom, main house bathroom in the hall, and the back yard.

OFF LIMITS areas include kitchen (currently not using kitchen area due to COVID), one bedroom/loft upstairs, master bedroom and bathroom, the attached two-car garage, and entire second floor of home.

Required postings were all present. Postings included:
License
Emergency Disaster Plan
Earthquake checklist
Notification of Parents Rights
Seat belt safety laws

Last Fire Drill 06/15/2021
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2021
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 3
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: RAIKAR, KIRAN
FACILITY NUMBER: 013422894
VISIT DATE: 08/06/2021
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
26
27
28
29
30
31
32
 The Licensee Health and Safety training is completed, CPR and First Aid certificate is current and expires 04/03/2023. The applicant completed and received a certificate in mandated reporter training on 11/11/2019. The applicant is following the immunization laws which pertains to all day care providers. Reviewed 3 (three) children files reviewed and current staff working today at the child care. The licensee is in ratio today. The licensee maintains her roster and provided LPA copy.

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

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: RAIKAR, KIRAN
FACILITY NUMBER: 013422894
VISIT DATE: 08/06/2021
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
26
27
28
29
30
31
32
Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list



There are no deficiencies cited today. A copy of this report was provided to licensee and is to remain in the facility records for a period of three years. A notice of site visit was also provided and is required to be posted for 30 days. This entire report was read to licensee by LPA. Exit interview conducted.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3