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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422961
Report Date: 11/30/2022
Date Signed: 11/30/2022 02:24:26 PM


Document Has Been Signed on 11/30/2022 02:24 PM - 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:GUPTA, JAGDEEPFACILITY NUMBER:
013422961
ADMINISTRATOR:GUPTA, JAGDEEPFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 507-9583
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:14CENSUS: 6DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Licensee, Jagdeep GuptaTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with Licensee, Jagdeep Gupta for 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 and her helper, supervising three infants and 3 preschoolers. Capacity and ratio requirements of children was observed in compliance today. Licensee lives in the house with her husband and two minors. A review of records indicates that all adults working or living in the home who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The home is a two-story home with 4 bedrooms, 2.5 bathrooms, living room, family room, kitchen, dining room, garage with laundry room and back yard. The hours of operation are 8:30AM- 5:30PM, Monday -Friday. The facility has liability insurance through Markel company.
ON-LIMIT AREAS are the entire first floor which consist of the family room with half bathroom used for daycare children, living room, kitchen, and dining room.
OFF-LIMIT AREAS are the entire second floor which consist of all 4 bedrooms, 2 bathrooms and the garage, and made inaccessible to children by locked doors, safety gates and visual supervision.

LPA inspected the house for health and safety hazards. Day-care Area is clean, orderly, and equipped with age appropriate toys and equipment for children, indoors and outdoors. Home has a working telephone, a working smoke and carbon monoxide detector, and a fire extinguisher that meets the minimum requirements. There are no bodies of water or Fireplace in the Day-care area. 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. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. The Facility has a cot in good condition and each child have their separate blankets. Licensee states there are no guns or weapons of any kind in the home. Licensee and helper have valid CPR. Licensee provides daily snacks and meals. Discipline policy is redirection. Provider is reminded of NO walker, exersaucers, jumpers, bouncers, and any similar items to be used for children in care and shall be made inaccessible. Smoking is prohibited in family childcare homes. All required postings are properly posted. LPA discussed safe sleep guidelines and advised to document infant's sleep checks.



See next page..
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2022
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: GUPTA, JAGDEEP
FACILITY NUMBER: 013422961
VISIT DATE: 11/30/2022
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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.

No deficiency was cited today.



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

Exit interview conducted and report was reviewed with the licensee, Jagdeep Gupta.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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