013422777-4-14-2023-52-CC-JSAI-CQVNJ8-20230414102956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422777
Report Date: 04/14/2023
Date Signed: 04/14/2023 10:30:17 AM

Document Has Been Signed on 04/14/2023 10:30 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	VERMA, MONIKA		FACILITY NUMBER:	013422777
ADMINISTRATOR:	VERMA, MONIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 996-3376
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 2	DATE:	04/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Licensee, Monika Verma		TIME COMPLETED:	11:10 AM

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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee, Monika Verma for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during this inspection was Licensee, supervising 2 preschoolers. Licensee lives in the house with her husband and two children. The home is a two-story home with 4 bedrooms, 3.5 bathrooms, kitchen, pantry, dining room, family room, laundry room, garage and back yard. The hours of operation are 9:00am to 5:30pm Monday -Friday.

Day care area: are the family room, kitchen, dining room and half bathroom.

Off-limit-areas: entire second floor and garage. All off limit areas are inaccessible by closed and/or locked doors and visual supervision.

LPA inspected the house for health and safety hazards. Daycare Area is clean, orderly, and equipped with age appropriate toys. Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher. There are no bodies of water in the day care area. There is no fireplace in the daycare area. Kitchen cabinets are latched to prevent children from access. There is a child safety gate located at the bottom of the stairs to prevent access to the stairs and upper levels to children in care. There are child size tables and chairs for snack and activities. Licensee states there are no guns or weapons of any kind in the home. There are no pets in the home. The outdoor play area is fenced and is free from defects and dangerous conditions.

Licensee have valid CPR and mandated reporter training on the file. Licensee provides daily snacks and meal. Discipline policy is redirection. The licensee conducts and documents Fire/Disaster Drills at least twice a year, and the log indicates a drill was conducted 02/21/2023. LPA reviewed children’s files. All the files are complete and up to date. All required postings are properly posted. LPA discussed safe sleep guidelines.

see next page..

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: VERMA, MONIKA	FACILITY NUMBER: 013422777
	VISIT DATE: 04/14/2023

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During Inspection, Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

LPA discussed the safe sleep regulations with licensee 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 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.

Licensee was reminded about Mandated Reporter training available on CCLD website. Training must be completed every 2 years. Training can be taken online at www.mandatedreporterca.com

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/inspection-process.

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

There are no deficiencies cited today.

Exit interview conducted and report was reviewed with the licensee, Monika Verma.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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