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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422672
Report Date: 06/30/2022
Date Signed: 06/30/2022 10:05:19 AM


Document Has Been Signed on 06/30/2022 10:05 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:DUBEY, SEEMAFACILITY NUMBER:
013422672
ADMINISTRATOR:DUBEY, SEEMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 790-3418
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:14CENSUS: 4DATE:
06/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Seema Dubey- LicenseeTIME COMPLETED:
10:15 AM
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On 06/30/22, Licensing Program Analyst (LPA) Briana Plumboy met with licensee Seema Dubey for an UNANNOUNCED REQUIRED 1 YEAR RANDOM INSPECTION. Present for this visit was 4 preschool age children, licensee's two fingerprint cleared adult daughters 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 (side 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. 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 current and expires 7/31/23. Per licensee, there are no firearms in the home. The licensee conducted and documented a fire and disaster drill with the last drill conducted on 6/2/22. The licensee is in compliance with the immunization law which pertains to providers. The licensee is documenting sleep patterns and checks during nap times.
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 NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022
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: DUBEY, SEEMA
FACILITY NUMBER: 013422672
VISIT DATE: 06/30/2022
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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 Seema Dubey 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 Seema Dubey 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 Seema Dubey.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC809 (FAS) - (06/04)
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