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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420104
Report Date: 01/26/2022
Date Signed: 01/26/2022 10:58:59 AM

Document Has Been Signed on 01/26/2022 10:58 AM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SUMRA, NASREENFACILITY NUMBER:
013420104
ADMINISTRATOR:SUMRA, NASREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 209-3917
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
01/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Nasreen Sumra- LicenseeTIME COMPLETED:
11:10 AM
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On 01/26/22 at 9:05am, Licensing Program Analyst Briana Plumboy and April Wright met with licensee Simaranjit Kaur for an UNANNOUNCED REQUIRED 1 YEAR INSPECTION. Present for this visit was Paul Buttner, licensees fingerprint clear and associated assistant Simaranjit Kaur and 9 children in care (3 infants, 6 preschool age). The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 7:00am until 6:00pm.
The home is two levels. The licensee stated the living room was the primary room for children. The home is orderly and neat with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the living room, family room, 2 dining rooms, and bathroom located on the first level of the home. The OFF LIMIT AREAS are the entire second level of the home, kitchen, and garage which will be inaccessible by closed and/or locked doors and visual supervision. There is a gate located at the bottom of the stairs to prevent access to the stairs and second level of the home. The ISOLATION AREA will be an area inside the living room. The BACKYARD play area is fenced. There is a locked shed located inside the backyard. Per licensee, the children only utilize the right side of the backyard which is fenced. There are toys and learning materials. There are no pools, hot tubs or any other bodies of water present in the on limits areas today. There is a bird bath located in the backyard in an off limits area and is made inaccessible by the fence around the children's outside play area. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible to children in care today.
The home has a fully charged 2A10BC fire extinguisher and and working telephone. The smoke detector and carbon monoxide detectors were in working order during today's inspection. The licensee's CPR and First Aid certificate is current and expires 06/18/23 and assistant Simaranjit's expires 08/08/22. The licensee's mandated reporter training is complete and she received a certification of completion on 03/26/18 and assistant Simaranjit Kaur's mandated reporter training expires 06/16/22. The fireplace is screened to prevent access by children. The last documented disaster drill was conducted on 09/03/21. Both licensee and her assistant are in compliance with the immunization law. Per licensee, there are no firearms in the home. 5 Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
Wynn Norona
Briana Plumboy
DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
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: SUMRA, NASREEN
FACILITY NUMBER: 013420104
VISIT DATE: 01/26/2022
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Incidental Medical Services (IMS) policy was discussed. 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 encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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 reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with licensee Nasreen Sumra 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 Nasreen Sumra 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.

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

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Nasreen Sumra.

SUPERVISOR'S NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC809 (FAS) - (06/04)
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