013422787-12-15-2021-52-CC-KPHN-C9QS68-20211215123530

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422787
Report Date: 12/15/2021
Date Signed: 12/15/2021 12:35:38 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:	TRIVEDI, POOJA & ROHIT		FACILITY NUMBER:	013422787
ADMINISTRATOR:	TRIVEDI, POOJA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(313) 515-5514
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY:	14	CENSUS: 12	DATE:	12/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Pooja Trivedi		TIME COMPLETED:	01:15 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 12/15/2021 at 11:00am Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Pooja Trivedi. Present for this inspection was 12 preschool-aged children along with two fingerprinted and associated helpers. Also residing in the home is the licensee's fingerprinted and associated husband, Rohit Trivedi. Licensee also informed LPA that her in laws resides at a separate unit, who are also fingerprinted and associated to her facility (Pramila & Ramniklal Trivedi). The Licensee also have two school-aged children (7 &13) children but are attending school during the day. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 9:00am to 5:00pm. ON LIMITS: family room (main area of the day care), hallway bathroom, full backyard, outdoor bathroom; isolation area is the shaded area outside if children is sick OFF LIMITS: kitchen, living room, garage, 3 bedrooms, and separate unit (in-law's house). Off limit areas are inaccessible by closed and/or locked doors, gates, and visual supervision. The home is single story, which is neat and clean, with heating and ventilation for safety and comfort. A child safety gate is required near the kitchen area as the Licensee is using a gate to keep children in the family room area. There were ample age appropriate toys/materials that were observed to be safe and in good condition. Toxins, medicines, and hazardous items were inaccessible during today's inspection. There is a fully charged 2A10BC fire extinguisher, and a working dual carbon monoxide and smoke detector. LPA did not observe a fireplace present at the facility. Per licensee, there are no firearms or pets or any bodies of water in the home. The licensee conducts and documents fire drill log indicates a drill was conducted 8/27/21. All required licensing documents are posted and visible for public review. SEE LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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: TRIVEDI, POOJA & ROHIT	FACILITY NUMBER: 013422787
	VISIT DATE: 12/15/2021

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
26
27
28
29
30
31
32

At 11:45am, 6 children files were reviewed and found to be complete. 3 staff members were reviewed and found to be missing LIC 9052 (Employee Right's); LPA gave a copy of LIC 9052 and licensee was able to correct it immediately. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Licensee has proof of the required immunizations. The licensee and two other staff members have required mandated reporter training that is completed along with CPR and First Aid training.

Exit interview conducted. Appeal rights and notice of site visit was given to licensee to post for 30 days.

No deficiencies were cited for today's inspection

Facility Representative 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.

Facility Representative was reminded that California Law requires licensed Child Care Centers 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 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Facility Representative was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2