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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422961
Report Date: 12/23/2020
Date Signed: 12/23/2020 03:39:27 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:GUPTA, JAGDEEPFACILITY NUMBER:
013422961
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
12/23/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jagdeep GuptaTIME COMPLETED:
11:30 AM
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DUE TO COVID-19 PANDEMIC THIS VISIT IS BEING CONDUCTED BY WHATSAPP.

On 12/23/2020 at approximately 10:00 AM, Licensing Program Analyst (LPA), Renee Reed, met with Licensee Jagdeep Gupta for an Announced Case Management- Change in Capacity Increase Inspection via WhatsApp . Present for this inspection were the Licensee, spouse Ajay Gupta, 14 year old daughter and 10 year old son. Licensees hours of operation are Monday thru Friday, 9:00 Am to 6:00 PM.

The home was toured to conduct a Health and Safety Inspection. The home is a two story 4 bedroom two in 1/2 bathroom and remains acceptable as the initial licensing inspection on 1/12/2018 .

OFF LIMIT AREAS are the entire 2nd floor which will be barricaded by a gate by the stairs, and garage which will be inaccessible by closed and/or locked doors and require visual supervision at all times.
The ON LIMIT AREAS are the living, dining room, kitchen, family room(child care area), and backyard.
The ISOLATION AREA is the living room.

Outdoor play area is the backyard which is completely fenced and will have supervision at all times. There was previously a swimming pool in the backyard, which was removed on 10/30/2019 and now the backyard is fully cemented. Licensee indicated she contacted Community Care Licensing twice in 2019 about the removal of the swimming pool and was told to send a letter in. Licensee emailed a copy of the permit to LPA Reed for review during inspection.
The outdoor play area is free from defects or dangerous conditions. There is an ample supply of toys and activities available for children, and they are in good condition and age appropriate. 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 today. See 809-C
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee ReedTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
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: GUPTA, JAGDEEP
FACILITY NUMBER: 013422961
VISIT DATE: 12/23/2020
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Combination smoke/carbon monoxide detector was tested and in good working order in the child care room. Additional smoke detectors was observed through out the home as well. A fully charged fire extinguisher with a 3A40BC was present. The licensees' Pediatric CPR and First Aid certificate is current and expires 8/21/2021. The licensee has proof of the required immunization's and mandated reporter training was completed on 11/27/2019. LPA reminded Licensee that Mandated Reporter Training is required and to be renewed every two years, as well as, CPR and First Aid.

Fire Clearance was granted by the Dublin Fire Prevention Services on 11/3/2020 and noted ( 2nd FLOOR AND GARAGE OFF LIMITS TO CHILDREN).

LPA provided a copy of Safe Sleep-in-Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?" and a copy of the new California Car Seat Law Changes.

Licensee is approved for the Change of Capacity Increase as of 12/23/2020.

Notice of Site Visit was provided and shall be posted in the facility for 30 days.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Renee ReedTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2020
LIC809 (FAS) - (06/04)
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