013422672-7-19-2021-52-CC-BPLY-C53RZW-20210719132836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422672
Report Date: 07/19/2021
Date Signed: 07/19/2021 01:28:42 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:	DUBEY, SEEMA		FACILITY NUMBER:	013422672
ADMINISTRATOR:	DUBEY, SEEMA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 790-3418
CITY:	UNION CITY	STATE: CA	ZIP CODE:	94587
CAPACITY:	14	CENSUS: 7	DATE:	07/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Seema Dubey- Licensee		TIME COMPLETED:	01:35 PM

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	On 07/19/21, Licensing Program Analyst (LPA) Briana Plumboy met with licensee Seema Dubey for an UNANNOUNCED REQUIRED 1 YEAR RANDOM INSPECTION. Present for this visit was 2 infants, 5 preschool age children, licensee's assistant Kalpana Shah, licensee's two fingerprint cleared adult daughters Kriti Dubey and Kambi Dubey, and licensee's fingerprint cleared and associated husband Nidheesh Dubey. The home was toured to conduct a Health and Safety Inspection. This facility currently currently operates Monday through Friday from 8:15am until 6:00pm. The home is two stories. The home is neat and clean with heating and ventilation for safety and comfort. The ON LIMIT AREAS are the playroom (garage), downstairs bedroom, both downstairs bathrooms, the family room, and the backyard. The OFF LIMIT AREAS are the living/dining/kitchen combo, the entire second level of the home, as well as the two car garage which will be inaccessible by closed and/or locked doors and visual supervision. There is a gate located near the bottom of the stairs to prevent access of children to the stairs as well as the off limit areas. The ISOLATION AREA will be the downstairs bedroom. The BACKYARD play area is fenced. There are toys. There are no pools, hot tubs or any other bodies of water present in the on limit areas during today's inspection. 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 during todays inspection. The garage is not permitted by the City of Union City and is not a converted garage. The fire clearance was granted and allows licensee to utilize the garage for child care, but licensee is aware children may not eat or sleep inside the garage. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. The licensee's CPR and First Aid certificate is current and expires 07/2023, and her assistant K. Shah's CPR and First Aid expires 08/2021. The fireplace is screened to prevent access by children. The licensee is in compliance with the immunization law. The licensee's mandated reporting training is expired, and she is currently working on completing the training. Per licensee, there are no firearms in the home. The licensee conducted and documented a fire and disaster drill with LPA Plumboy present. Facility roster reviewed and copy obtained. The licensee is in ratio today. Forms are posted and visible for public review. See 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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: DUBEY, SEEMA	FACILITY NUMBER: 013422672
	VISIT DATE: 07/19/2021

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

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

Effective August 1, 2003 California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

The licensee was also reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

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 reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list

There are no deficiencies cited. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. This entire report was read to licensee by LPA Plumboy. Appeal rights provided and discussed. Exit interview conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana Plumboy	TELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

LIC809 (FAS) - (06/04)

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