073408683-4-26-2023-52-CC-MPRE-CR9RMW-20230426130924

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408683
Report Date: 04/26/2023
Date Signed: 04/26/2023 01:09:31 PM

Document Has Been Signed on 04/26/2023 01:09 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:	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: 3	CENSUS: 2	DATE:	04/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:53 AM
MET WITH:	Kanika Agarwal		TIME COMPLETED:	01:08 PM

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 4/26/2023 at 11:48am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Kanika Agarwal for a Required - 1-Year Inspection. Present during the inspection was the Licensee, her husband Atul Kumar, and two (2) school age children. Licensee lives in the home with her husband and their sixteen (16) year old daughter. Licensee’s home was toured for a health and safety inspection. The facility operates from 7:00am – 6:30pm, Monday - Friday. ON LIMITS AREA: Family Room, Living Room, Kitchen, and Downstairs Bathroom and Backyard OFF LIMITS AREA: Entire 2nd Floor, Downstairs Bedroom, Laundry Room and Garage ISOLATION AREA: Family Room The facility is a two-story home owned by the Licensee. The inside of the home was observed to be neat, clean with ample age-appropriate materials for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee stated that she provides all food for the children. All food that is brought from the children’s home will be properly labeled and stored. Licensee stated that she does provide after school transportation. There are no firearms and no pets in the home. There is one (1) fully charged 3A40BC fire extinguisher across from the laundry room. There is one (1) working smoke/carbon monoxide detector in the living room, family room, in the hallway across from the bathroom and at the bottom of the stairs. The electric fireplace in the living room is locked and does not get hot to the touch, making it inaccessible to the children in care. The home is equipped with central heat and air for proper ventilation. The backyard is fully fenced, clean and well maintained. Licensee stated that the children will play at the park located directly across the street as well. LPA did not observe any harmful bodies of water in or around the home.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AGARWAL, KANIKA	FACILITY NUMBER: 073408683
	VISIT DATE: 04/26/2023

NARRATIVE

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Licensee is operating within their licensed capacity and is in ratio. Licensee’s Health and Safety training with lead poisoning component has been completed. Licensees’ Pediatric CPR and First Aid training is complete and expires 7/11/2023. Licensee’s Mandated Reporter training is complete and expires 4/7/2024. LPA obtained the fire/disaster drill log, log is complete with the last drill logged 12/12/2022. All adults living in the home have obtained a criminal record clearance. All required forms are posted by the front door of the home. LPA obtained the children’s files and facility roster. All files were complete.

Licensee was reminded that California Law requires Licensee 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. The Licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.
Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting http://www.mandatedreporterca.com

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.

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.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: AGARWAL, KANIKA	FACILITY NUMBER: 073408683
	VISIT DATE: 04/26/2023

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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.

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.

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 Licensee Kanika Agarwal.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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