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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416757
Report Date: 11/02/2022
Date Signed: 11/02/2022 04:27:23 PM

Document Has Been Signed on 11/02/2022 04:27 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:ANJALI, FNUFACILITY NUMBER:
434416757
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 7DATE:
11/02/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Fnu AnjaliTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marilou Monico, conducted an unannounced Case Management Inspection in response to licensee's request to increase the capacity from 8 to 14 children. Also present in the home were licensee's husband, her two school age children ages 5 years old, and five (5) daycare children including three (3) infants and two (2) preschool age. LPA advised licensee that children living in the home who are under 10 years old are counted in the ratio. Licensee and her husband are the adults residing in the home. Days and hours of operation are Monday thru Friday from 8 AM to 6 PM.

The indoor and outdoor areas of the home were inspected by LPA. LPA observed sufficient toys and play equipment for the day care children. Bathroom used by children was observed to be clean and in good condition. Off limit areas inside the home: entire upstairs (Bedrooms #3 & 4, bathroom, & family room), one bathroom downstairs, and garage. Off limit areas outside the home: both side yards, two storage sheds, and right side section of the backyard. There were no bodies of water observed. Per Licensee, there are no weapons in the home. LPA observed a fully charged 3A40BC fire extinguisher, functioning carbon and smoke detectors, barricaded fireplace, gated stairs, and fenced backyard. Cleaning compounds, detergents, medications, sharp objects, and other similar items were stored inaccessible to children. LPA explained to licensee the ratio and capacity chart.

Licensee's Mandated Reporter Training certificate expires on January 15, 2024. Pediatric CPR/First Aid for licensee expires on December 11, 2023. Licensee has immunization in measles, pertussis, and flu.

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.

Continuation on next page:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ANJALI, FNU
FACILITY NUMBER: 434416757
VISIT DATE: 11/02/2022
NARRATIVE
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Fire clearance was granted on October 18, 2022.

As a result of this inspection, deficiency was cited on the following page:

Exit interview was conducted and report was reviewed with the Licensee, Fnu Anjali.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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Document Has Been Signed on 11/02/2022 04:27 PM - It Cannot Be Edited


Created By: Marilou Monico On 11/02/2022 at 03:59 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: ANJALI, FNU
FACILITY NUMBER: 434416757

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/03/2022
Section Cited
CCR
102416.5(b)(3)

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For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following:(3) More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met. No more than two infants are cared for during any time when more than six children are cared for.
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Licensee states she will remove one child in care to be in compliance. Licensee states she will submit a written plan of correction by 11/03/22.
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This requirement is not met as evidenced by:
LPA observed seven (7) children present in the home including licensee's two school age children ages 5 years old and five (5) daycare children including three (3) infants and two (2) preschool age. This poses an immediate risk to the health, safety, and personal rights of children in care.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022


LIC809 (FAS) - (06/04)
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