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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214763
Report Date: 09/22/2021
Date Signed: 09/22/2021 02:28:44 PM

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, ELIZABETHFACILITY NUMBER:
010214763
ADMINISTRATOR:MAJUMDAR, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 396-6591
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:12CENSUS: 8DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Elizabeth MajumdarTIME COMPLETED:
02:45 PM
NARRATIVE
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On September 22, 2021 at approximately 11:15am Licensing Program Analyst (LPA) Russ Haderer met with licensee Elizabeth Majumdar for the purpose of conducting an unannounced annual inspection. Present for today’s inspection was licensee’s fingerprint and TB cleared husband and her sister Evelyn Sabido (assistant), and 8 children in care (1 infant; 6 two year-old; 1 four year-old). The hours of operation will remain Monday-Friday, 8:00 AM to 6:00PM.

ON LIMITS: Family room (daycare room), kitchen, dining room, house bathroom on 1st floor, deck area in the center of backyard area. Licensee reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products and laundry soaps. There are no accessible hazardous cleaning chemicals or other liquids in the on-limits area.

OFF LIMITS: Entire second floor, first floor bedroom on the left side of the house bathroom, laundry room, attached 2-car garage, locked storage shed in the backyard and side yards of the backyard. Off limit areas are inaccessible by closed and/or locked doors and visual supervision.



The facility is a two-story 5-bedroom, 3 bathroom home with a laundry room, kitchen, living room, family room (day care area) with attached 2-car garage. Toxins, medicines, and hazardous items were inaccessible during today's inspection. Per the licensee, the ISOLATION AREA will be in the dining room area where licensee can see and monitor the child away from the other children in care.

The home has heat and ventilation for safety and comfort. The outdoor play area is fenced, and free from defects and dangerous conditions. There were ample age appropriate toys that were observed to be safe and in good condition. LPA did not observe any bodies of water, hazardous materials, or toxins accessible to children on the premises during the inspection.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MAJUMDAR, ELIZABETH
FACILITY NUMBER: 010214763
VISIT DATE: 09/22/2021
NARRATIVE
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There is a fully charged 3A40BC fire extinguisher located in the dining room, working (tested) carbon monoxide and smoke detectors, telephone. There is a fireplace is in the off limits living room with a glass screen and an additional unused fireplace in the family room daycare area with a screen and additional mattress pad blocking for safety. 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 8/11/2021. All required licensing documents are posted and visible for public review.

At 1:00pm, 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 does not carry liability insurance. Signed acknowledgement forms from each parent available in each child’s file. The Licensee’s Health and Safety training is completed. Licensee and assistant’s pediatric CPR/First Aid certificate are current and expire 04/17/2023. Licensee and assistant’s mandated reporter (verified AB1207), expires on 04/24/22. The licensee and assistant and all adults living in the home are in compliance with the immunization laws which pertains to day care providers.

LPA reminded the licensee of the following: Mandated Reporter training is to be renewed every two years, CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.



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 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.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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: 09/22/2021
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.


See attached 809-D forms for deficiencies cited today: This report will remain on file for 3 years.

A review of operating safely during the Covid-19 pandemic (RAST) was conducted.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Elizabeth Majumdar. LPA left the home at 2:45PM.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Observation, the licensee did not comply with the section cited above as the crib did not contain a fitted and firm mattress which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/15/2021
Plan of Correction
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Licensee will order a properly sized firm crib mattress for children to use while sleeping in the crib.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in as there were loose blankets and miscellaneous objects (toys) in the crib which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2021
Plan of Correction
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Licensee cleared the items during the inspection and was advised that nothing other than a tight fitting sheet shall be used in the crib when children are using it for napping.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4