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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420062
Report Date: 03/06/2025
Date Signed: 03/06/2025 02:43:36 PM

Document Has Been Signed on 03/06/2025 02:43 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KAUR, HARMANJITFACILITY NUMBER:
013420062
ADMINISTRATOR/
DIRECTOR:
KAUR, HARMANJITFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 833-1855
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Licensee, Harmanjit Kaur TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with the licensee, Harmanjit Kaur, for an announced case management visit. This facility had been on inactive status effective 4/4/2023, and the licensee would like to have it reinstated to active status. Per licensee, the operational hours will be Monday to Friday, from 8:00 AM to 6:00 PM.
ON-LIMIT AREAS: Family room, kitchen, and ½ bathroom on the first level.
OFF-LIMIT AREAS:
Entire upstairs area, living room, dining room, conservatory, laundry room, bedroom on the first floor, and garage.

LPA Saini and the licensee inspected the facility for health and safety hazards. All hazardous materials were found to be kept inaccessible to children in care. The licensee will be utilizing the right side of the backyard for the children in care. During the inspection, LPA did not observe any bodies of water. The licensee’s CPR and First Aid certificates are valid until 01/12/2027, and the Mandated Reporter certificate is valid until 03/02/2027. The facility is equipped with a working smoke detector, a functioning carbon monoxide detector, and a 2A-10BC fire extinguisher. Per licensee, there are no guns or weapons in the home.

During this visit, the following items were addressed:

  • Required forms for the facility and children's files.
  • Required forms to be posted at the facility.
  • Unusual incident reporting requirements.
  • Infant safe sleep practices.


Prior to placing the facility on active status, the licensee's son and daughter-in-law are required to obtain fingerprint clearance.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and the report was reviewed with the licensee, Harmanjit Kaur.

Wynn NoronaTELEPHONE: (510) 421-1324
Jyoti SainiTELEPHONE: 510-298-7052
DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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