010214763-7-15-2019-52-CC-JPLA-BE4NSX-20190715104351

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214763
Report Date: 07/15/2019
Date Signed: 07/15/2019 10:43:57 AM

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:	MAJUMDAR, ELIZABETH		FACILITY NUMBER:	010214763
ADMINISTRATOR:	MAJUMDAR, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 794-7542
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	12	CENSUS: 11	DATE:	07/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Elizabeth Majumdar		TIME COMPLETED:	11:00 AM

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	Licensing Program Analyst (LPA) Julia Placencia arrived at 8:55am for an unannounced Annual/Random Inspection, and met with Licensee Elizabeth Majumdar. Present for this inspection were four infants, seven preschool age children, and the licensee's fingerprint cleared sister/helper Evelyn Sabido. Also residing in the home are the licensee's fingerprint cleared spouse, son, and brother. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 8:00am to 6:00pm. ON LIMITS: Kitchen, dining room, family room, first floor bathroom, backyard. OFF LIMITS: Entire second floor, first floor bedroom, laundry room, garage, storage shed. Off limit areas are inaccessible by closed and/or locked doors and visual supervision. The home is two story, which is neat and clean, with heating and ventilation for safety and comfort. The stairway had a child safety gate in place. The outdoor play area is fenced, has a wooden deck, and is free from defects and dangerous conditions. There were ample age appropriate toys that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Fire extinguisher, carbon monoxide and smoke detectors meet State Fire Marshal Standards. The fireplace is located in the off limits living room and has glass doors. Per licensee, there are no firearms in the home. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 12/10/18. All required licensing documents are posted and visible for public review. At 9:40am, children's files were reviewed and found to be complete. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. The licensee's Pediatric CPR/First Aid certificate is current and expires 7/2020, and helper Evelyn's expires 5/25/21. Licensee and helper have proof of the required immunizations, and mandated reporter training was completed on 3/3/18 for both licensee and helper. Safe Sleep practices were discussed, and new car seat laws were provided. Licensee was reminded that children are never to be left in a parked vehicle. ***Continued on LIC809C....

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

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: MAJUMDAR, ELIZABETH	FACILITY NUMBER: 010214763
	VISIT DATE: 07/15/2019

NARRATIVE

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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 is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

The following form is to be updated and submitted to CCL by 7/22/19:

LIC 610 Emergency Disaster Plan

There were no deficiencies cited during today's inspection. This report shall remain on file for 3 years. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days.

Exit interview conducted with Elizabeth Majumdar. Copy of report and appeal rights provided.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia Placencia	TELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019

LIC809 (FAS) - (06/04)

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