073408683-8-2-2024-52-CC-MPRE-D7RTF2-20240802144050

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408683
Report Date: 08/02/2024
Date Signed: 08/02/2024 02:40:59 PM

Document Has Been Signed on 08/02/2024 02:40 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/ DIRECTOR:	AGARWAL, KANIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 709-8946
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 5	CENSUS: 2	DATE:	08/02/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Kanika Agarwal		TIME VISIT/ INSPECTION COMPLETED:	02:40 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 8/2/2024 at 1:00pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Kanika Agarwal for an unannounced annual/random inspection. Present during the inspection was the Licensee, her husband and her seventeen (17) year old daughter. One (1) school age child arrived at 1:20pm. Licensee’s home was toured for a health and safety inspection. The facility operates from 7:00am – 6:30pm, Monday – Friday. Licensee primarily cares for school age children. 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’s learning and play. All toxins, medications, cleaning products, and hazardous materials were observed to be in inaccessible areas. Licensee provides all food for the children which was observed to be properly maintained and stored. All food that may be brought from the children’s home will be properly labeled and stored. All off limit areas in the home are made inaccessible with locks. Licensee stated she does transport children from the nearest Elementary School, there are no pets, and no firearms in the home. Page 1 of 4

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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: 08/02/2024

NARRATIVE

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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. Children do not nap at the facility but are given areas to rest if they need to. The backyard was observed to be fully fenced, clean, well maintained with ample age-appropriate materials for the children. Licensee stated she mostly takes the children to the neighborhood park that is located across the street from the home. LPA did not observe any harmful bodies of water in or around the home.

The facility is operating within its licensed capacity and is in ratio. Licensee’s Health and Safety training has been completed and EMSA approved Pediatric CPR & First Aid is complete and expires 8/26/2025. Licensee’s Mandated Reporter training has expired. Licensee was informed that the training must be completed by 8/6/2024. Proof of completion will be sent to LPA. LPA obtained the fire/disaster drill log. Fire/disaster drills have been conducted and recorded within the last six (6) months with the last drill logged 5/14/2024. 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 files. All files were complete.

No deficiencies were cited during LPAs inspection.

Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's authorized representatives, and to Community Care Licensing Division (CCLD) within 24 hours by phone. Within seven (7) days of the incident, Licensees must submit the Unusual Incident/Injury form (LIC 624B) to CCLD. Licensee was reminded that any structural changes or additions to the home must be reported to CCLD. Children’s Roster must be properly maintained, and fire/disaster drills must be conducted every six (6) months and documented. EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every two (2) years by visiting mandatedreporterca.com/. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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: 08/02/2024

NARRATIVE

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

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.

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

During the exit interview, Licensee Kanika Agarwal, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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: 08/02/2024

NARRATIVE

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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 information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

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 Licensee Kanika Agarwal.

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SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

LIC809 (FAS) - (06/04)

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