073408683-7-28-2021-52-CC-MPRE-C5CNTU-20210728104520

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408683
Report Date: 07/28/2021
Date Signed: 07/28/2021 10:45:25 AM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/28/2021 10:45 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:	AGARWAL, KANIKA		FACILITY NUMBER:	073408683
ADMINISTRATOR:	AGARWAL, KANIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 709-8946
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kanika Agarwal		TIME COMPLETED:	10:50 AM

NARRATIVE

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On 7/28/2021 at 9:45am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Kanika Agarwal for an unannounced annual inspection. Present during the inspection was licensee and her fingerprint cleared husband, Atul Kumar. There are no children present today. Licensee stated that she has been closed since March 2020 due to the Covid-19 pandemic. She plans to reopen August 2021. The Licensee’s home was toured for a health and safety inspection. When the Licensee opens in August, the operating hours will be 7:00am-6:30pm Monday – Friday.

ON LIMITS AREA: Family Room, Living Room, Kitchen and Downstairs Bathroom

OFF LIMITS AREA: Entire 2nd Floor, Downstairs Guest Room, Backyard and Garage
ISOLATION AREA: Living Room

The facility is a two story home owned by the Licensee. The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms or pets in the home.

The home has one (1) fully charged 3A40BC fire extinguisher located in the hallway by the stairs. There is a fire alarm in the entry way. One (1) working carbon monoxide/smoke detector combination in the living room, family room and in the hallway in front of the bathroom. The home is equipped with central heating and air for proper ventilation. LPA observed no bodies of water in or around the home.

The Licensee’s Health and Safety training has been completed and CPR and First Aid is complete and expires on 7/11/2023. Mandated Reporter training is complete and expires on 9/08/2021.

Cont on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AGARWAL, KANIKA	FACILITY NUMBER: 073408683
	VISIT DATE: 07/28/2021

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Since Licensee has no current enrollment no files were reviewed during this inspection. LPA discussed all documents needed for children's files as well as any helpers that may be needed.

Licensee was reminded that California Law requires 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 by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Licensee is reminded that ALL Licensees, 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 $3,000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter.
All fire/disaster drill must be conducted every six months and documented. The Licensee is reminded that any structural changes to the facility or additions to the childcare facility must be reported to Community Care Licensing.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Licensee for a signature. There are no deficiencies being cited today. This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

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