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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422066
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:35:29 PM


Document Has Been Signed on 03/07/2023 03:35 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:GENIUS KIDSFACILITY NUMBER:
013422066
ADMINISTRATOR:SAMIMI, KELLYFACILITY TYPE:
830
ADDRESS:11760 DUBLIN BLVD.TELEPHONE:
(925) 828-2081
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:24CENSUS: 10DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Director, Kelly SamimiTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA), Jyoti Saini met with director Kelly Samimi for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director.The licensee Jigna Modi arrived during the inspection. In addition to the director, and licensee, there are 10 children ( 2 infants and 8 toddlers) and 2 staff present today. The facility operates Monday - Friday from 8:30 AM to 5:30PM out of the dolphins and Seals classrooms. The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed.

There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit and a first aid backpack are available. The facility requires children to bring their own snacks and lunches daily as they do not provide food to the children as well as children bring their own water bottles and the facility refills them with a Brita water jug. All the Infants bottles are labeled. The center also conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on 2/22/2023.

LPA reviewed sign-in and out sheet. The center has a complete record of sign-in/out sheets by an authorized pick up person. There is a working fire alarm, a fully charged fire extinguisher, and a working telephone available.

All the Children records reviewed were complete. All children have a record of emergency identification information on file. LPA observed Individual Infant Sleep Plan (LIC9227) for all infants under the age of 12 months. LPA reviewed sleep record log for 15-minute checks. All the infants have a Needs and Services Plan in the file. The classroom has a diaper changing table, sleeping mats, and cubbies with children’s names on them. All staff has a criminal record clearance on file. The site Director has a current Pediatric First Aid/CPR certificate on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site always or present during off-site activities (field trips). Facility roster was reviewed, and a copy was obtained.

See next page...

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: GENIUS KIDS
FACILITY NUMBER: 013422066
VISIT DATE: 03/07/2023
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During inspection,

Director was reminded that all adults 18 and over, 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 Child Care Center. 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.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children currently. If 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

LPA discussed the safe sleep regulations with 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

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/process.

There are no deficiencies cited today.

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

Exit interview conducted and report was reviewed with the facility representative, Kelly Samimi

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2