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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416324
Report Date: 07/06/2021
Date Signed: 07/06/2021 03:48:34 PM

Document Has Been Signed on 07/06/2021 03:48 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SANGAR, ZARLAKTAFACILITY NUMBER:
274416324
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/06/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Zarlakta SangarTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joe Macias conducted an announced Prelicensing/ Relocation Inspection. The LPA met with the Licensee Zarlakta Sangar and disused the nature of today's inspection. The Applicant/ Licensee recently submitted an application for a relocation. The purpose of today’s inspection is to ensure the home is in compliance with Title 22 California Code of Regulations. Todays census is 8, upon arrival LPA observed 8 children (2 infants, 5 preschool age, 1 school age) present, the Applicant/ Licensee will receive a deficiency for providing unlicensed care. Unlicensed care was discussed with the Applicant/ Licensee. The Licensee and her husband Habib Sangar are the only adult who reside in the home. The Licensee also has four children, an eighteen month old son, a six and a half year old daughter, a ten year old son, and a twelve year old daughter who resides in the home. The hours of operation are Monday - Friday, 7am - 5:30pm. The Licensee's CPR and First Aid are current, and expire June 26, 2023. The Licensee has completed the Lead Poisoning Prevention Training. Applicant may obtain liability insurance upon receiving her license.

LPA toured the indoor and outdoor areas of the home during today's inspection. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the children in care. The home is orderly, and safe for the day care children. LPA did not observe a wall heater in the home (central heat). The off limit areas inside the home are: entire second floor, back yard, and detached garage.

LPA observed a fully charged 2A10BC fire extinguisher, working smoke, and carbon monoxide detectors. LPA did not observe a body of water. The Licensee states that she does not have weapons in the home. All detergents, cleaning compounds, poisons, medications, and other similar items are out of reach and inaccessible to children. Licensee states that he does not administer medications at this time.

Applicant will be using effective communication, as well as offering alternative activity as forms of discipline. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Discussed isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute. LPA informed applicant that fire/disaster drills must be practiced at least once every 6 months and documented.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SANGAR, ZARLAKTA
FACILITY NUMBER: 274416324
VISIT DATE: 07/06/2021
NARRATIVE
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The LPA also reviewed the Child Care Program COVID-19 Self-Assessment check list with the Applicant.

LPA also went over safe sleep for infants:

· Always place infants on their backs for sleeping.


· Use a tight-fitting sheet on the crib or play yard mattress.
· Do not hang any items from the crib or above the crib.
· Keep all items out of the crib or play yard.
· Pacifiers may be used as long as they do not have items attached to them.
· Infants should not be swaddled or have any items covering them while sleeping.


A review of staff records on July 6, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. A $500 immediate civil penalty. An ongoing $100 per day per violation continues until the violation(s) is corrected.

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

Type B deficiency cited. LPA conducted an exit interview with the Applicant/ Licensee and advised that a Small Family Child Care Home license will be issued pending management approval. A copy of this report was provided to the Licensee.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/06/2021 03:48 PM - It Cannot Be Edited


Created By: Joseph Macias On 07/06/2021 at 03:17 PM
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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SANGAR, ZARLAKTA
FACILITY NUMBER: 274416324

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/06/2021
Section Cited
HSC
1596.80

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Unlicensed Care:
No person, firm, partnership, association, or corporation shall operate, establish, conduct, or maintain a child care facility in this state without a current valid license, therefore, provided in this act.
upon arrival LPA observed 8 children (2 infants, 5 preschool age, 1 school age) present.
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Unlicensed care was discussed, the Applicant/ Licensee has submitted an application. The Applicant/ Licensee was previously licensed #274416163 at a different address and moved to the new address June 7, 2021. All required documents have been submitted, prelicensing inspection completed, and deficiency cleared 07/06/2021.

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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:Sandy Knight
LICENSING EVALUATOR NAME:Joseph Macias
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2021


LIC809 (FAS) - (06/04)
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