015700019-9-7-2023-52-CC-LDBX-CVFPVK-20230907113917

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700019
Report Date: 09/07/2023
Date Signed: 09/07/2023 11:39:24 AM

Document Has Been Signed on 09/07/2023 11:39 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	AEIMULA, ANIL		FACILITY NUMBER:	015700019
ADMINISTRATOR:	AEIMULA, ANIL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(225) 368-6002
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	09/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Anil Aeimula		TIME COMPLETED:	11:50 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 09/07/2023, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux met with Licensee Anil Aeimula for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was the licensee's fingerprint cleared staff, Priyanka Boga and ten (10) preschool age children. Licensee stated that the facility operates from Monday to Friday 8:00 AM to 6:00 PM. Age range is from 12 months - school age. LPA toured the facility to conduct a Health and Safety inspection. This single story home with 3 bedrooms and two bathrooms, the home has adequate with lighting, heating and ventilation for the safety and comfort of children in care. Per licensee this facility provides meals and snacks. On- Limit areas are the: Child care room, living and dining room, kitchen, backyard deck and backyard, and main bathroom. Off- Limit areas are the: All 3 bedrooms which includes master bedroom and bathroom, and garage.The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. The Isolation area will be a section of the living room, away from other children in care, until parents pick up. OUTDOOR AREA: The rear yard is used for outdoor play, it is fully fenced. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. There are age appropriate toys that appear to be safe and in good condition. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. The home has a fully charged 3A40BC fire extinguisher (located in the kitchen), dual working smoke detector/carbon monoxide detector (tested/functioning), fully stocked first aid kit, and telephone. There's no fireplace or heaters accessible to children. Per licensee, there are no firearms and no pets in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. Page 1 of 3 *Continued on LIC 809C*

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AEIMULA, ANIL	FACILITY NUMBER: 015700019
	VISIT DATE: 09/07/2023

NARRATIVE

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Records: At 10:20 AM LPA Dacanay Breaux reviewed five (5) children’s files and personnel records. No children under 12 months no sleep log and no sleep plans for review. There is a current roster available for review and copy obtained. The facility does have liability insurance and LPA reviewed expires on 05/13/24, licensee is reminded to forward a copy to the Regional office.

Provider Information Notices (PINs) & Quarterly Updates: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders, by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email notifications.

Criminal Record Clearance: Licensee 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.

Safe Sleep: LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Per licensee there is no medication being administered. Does not provide care for children under 12 months at this time. Licensee is reminded no baby bouncers, jumpers, walkers, drop down cribs are allowed during day care hours.

Page 2 of 3 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AEIMULA, ANIL	FACILITY NUMBER: 015700019
	VISIT DATE: 09/07/2023

NARRATIVE

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Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/resources/child-care-centers/.

MyChildCarePlan.org: Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law: During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care 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 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

CCLD Inspection Process: 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/process.

There is a TYPE B violation being issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights Provided. The licensee was provided a copy of appeal rights and the signature on this form acknowledges receipt of these rights. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee, Anil Aeimula.

END OF REPORT

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/07/2023 11:39 AM - It Cannot Be Edited

Created By: Lorraine Dacanay-Breaux On 09/07/2023 at 11:30 AM

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: AEIMULA, ANIL	FACILITY NUMBER: 015700019
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 1 out of "knives and scissors in the drawer and on the countertop" which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/07/2023
	Plan of Correction
1 2 3 4	Immediately, Licensee is to remove the knives/scissors from the drawer and/or put a child safety lock on the drawers. Remove the knives from the counter top and or put up higher. Items were removed before LPA left the child care home

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Chandra Charles

LICENSING EVALUATOR NAME:

Lorraine Dacanay-Breaux

LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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