013422787-1-6-2023-52-CC-KPHN-CMTQVQ-20230106113042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422787
Report Date: 01/06/2023
Date Signed: 01/06/2023 11:30:52 AM

Document Has Been Signed on 01/06/2023 11:30 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
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: 10	DATE:	01/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Pooja Trivedi		TIME COMPLETED:	11:45 AM

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 01/06/2023 approximately at 9:15AM, Licensing Program Analyst (LPA) Kelly Phan arrived at for an unannounced required inspection, and met with Licensee Pooja Trivedi. Present for this inspection was six (6) preschoolers and 4 infants along with one staff member. Also residing in the home is the licensee's fingerprinted husband and their two school aged children (8 &14) children. Per licensee, she also has her "in laws" who reside in a separate unit on the property, however they do not interact with day care children; both individuals has eligible clearance. 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: childcare room, outdoor bathroom, fenced backyard, shaded area in backyard (isolation area), and right side yard used for entry way to day care OFF LIMITS: garage, all four bedrooms, hallway bathroom, living room, kitchen, dining area, master bathroom, left side yard, outdoor shed, separate unit for "in laws", and front yard. Off limit areas are inaccessible by closed and/or locked doors, gates, child safety locks, 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 being used as licensee is using a gate to keep children in the day care room. There were ample age appropriate toys that were observed to be safe and in good condition. There is an alter in the child care area that is OFF limits to children. Per licensee, children are utilizing cots for sleeping and are given to parents weekly to clean. There were no toxins, medicines, and hazardous items accessible during today's inspection. There was a fully charged 2A10BC fire extinguisher, pull down fire alarm, working carbon monoxide, smoke detector, and telephone at the premises. LPA did not observe a fireplace at the home. Per licensee, there are no firearms or pets or smoking. The licensee conducts and documents fire drill log indicates a drill was conducted on 09/09/22. 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: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: TRIVEDI, POOJA & ROHIT	FACILITY NUMBER: 013422787
	VISIT DATE: 01/06/2023

NARRATIVE

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At 9:45AM, LPA toured the backyard area and found that it is safe and has plenty of space and toys to utilize for outdoor activities. LPA did not observe any pools, hot tubs, or similar bodies of water present. At 10:00am, 6 children's files were reviewed and found to be complete. Licensee has day care insurance from DC Insurance Services, INC on file from 03/23/2022 to 03/23/2023. The facility roster was reviewed, and a copy obtained. The licensee is in ratio today. Licensee and her helper have proof of the required immunizations. Her helper have required mandated reporter training that is completed as of 12/18/2022; licensee completed her mandated reporter training on 01/01/2023. CPR and First Aid training are also valid for her helper from 01/02/2022 to 01/02/2024; Licensee also had her CPR and First aid card valid from 06/12/2021 to 06/12/2023.

There were no deficiencies were cited for today's inspection

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with licensee Pooja Trivedi

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.

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: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

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: TRIVEDI, POOJA & ROHIT	FACILITY NUMBER: 013422787
	VISIT DATE: 01/06/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care at this time. 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 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.

Licensee 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.

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

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

LIC809 (FAS) - (06/04)

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