Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414621
Report Date: 12/04/2015
Date Signed 12/04/2015 03:23:55 PM

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:SONEJI, BIJALFACILITY NUMBER:
434414621
ADMINISTRATOR:SONEJI, BIJALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 474-0677
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:14CENSUS: 0DATE:
12/04/2015
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Soneji, BijalTIME COMPLETED:
04:00 PM
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LPA Esther Adeyemi met with Bijal Soneji for an announced pre licensing change of location visit . Analyst toured the home and yard, and reviewed the required day-care forms with the applicant today. Off-limit rooms were identified as all bedrooms, laundry, and garage. Day and hours of operation is Monday - Friday 6:30am -7:30pm Adults living in the home are applicant and her husband. Also living in the home is their parent and 2 daughters.
A review of records indicates that all adults living or working in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Applicant own the home. -Applicant states that there are no weapons in the home and no bodies of water present.
-Cleaning supplies, medicines, plastic bags and any hazards are stored inaccessible to the children.
Poisons are locked. -The outside area is fenced. -Smoke alarm was tested and works: Fire extinguisher is the correct size and is fully charged. -Applicant's CPR and First Aid is current through 07/18/17 15 hours preventative health and safety training is completed.
-Parents Rights Poster will be posted and visible to the parents, Emergency Disaster Plan and Earthquake Preparedness Checklist will be accessible and posted together, and a Facility Roster will be maintained and up to date. Posting requirements for site visits were also discussed.
-Emergency Evacuation procedures (applicant understands that fire drills must be practiced at least twice a year and documented), child discipline-no corporal punishment, isolation of sick children, supervision of children, capacity options, transportation of children, and requirements for reporting suspected child abuse, unusual incidents/injuries were discussed. Requirements for assistant and substitutes were also discussed today. A copy of the SIDS brochure was discussed and left at the home. To obtain copies of Licensing forms and Title 22 Regulations, visit the Department of Social Services website at www.ccld.ca.gov.

A LICENSE TO OPERATE A SMALL FCCH IS EFFECTIVE TODAY 12/04/15
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Esther AdeyemiTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2015
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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