013423054-2-9-2022-52-CC-JMIR-CBGSEE-20220209124838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423054
Report Date: 02/09/2022
Date Signed: 02/09/2022 12:48:45 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:	GENIUS KIDS DOUGHERTY		FACILITY NUMBER:	013423054
ADMINISTRATOR:	PUJA SARAF		FACILITY TYPE:	850
ADDRESS:	6044 DOUGHERTY ROAD		TELEPHONE:	(925) 999-9575
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	30	CENSUS: 6	DATE:	02/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Deepa Shah		TIME COMPLETED:	01:00 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 2/9/2022 at 10:30am Licensing Program Analyst (LPA) Jaylena Miller conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION. LPA met with Deepa Shah facility director, also present at the time of this inspection were 1 staff and 6 children. The facility is within ratio and capacity compliance today. Upon arrival LPA provided facility representative the form LIC 125. The facility was toured to conduct a Health and Safety Inspection. This program current operates Monday-Friday 9am-12noon out of classroom D101 and Will Hall for indoor play space. All classrooms were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces, the presence of working carbon monoxide detector, the smoke detectors/fire alarms are serviced annually and the last service was 6/4/2021 and a fully charged fire extinguishers size 3A40BC that is accessible throughout the facility. The bathrooms have age appropriate faucets and toilets in working condition. There is no outdoor play area as the facility is a part time preschool, no more than 5 hours per day or 15 hours per week, per child. There are no pools, hot tubs or other accessible bodies of water. Per director, there are no firearms present on the premises. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. The facility serves snacks, menu is also posted. LPA reviewed storage of food and reminded director that all food must be in original packaging or labeled with expiration date. The center also conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on 1/19/2022. A copy of the facility personnel roster and children’s roster were available for review and copy was obtained. LPA reviewed the file of 6 children enrolled in the program and 2 staff members files, who are fingerprint cleared, completion of Mandated Reporter training as well as proof of immunizations. S2 opens the facility and S1 closes the facility and have current CPR/First Aid certificates that expire 1/22/2024 and 11/12/2023 respectfully, and proof of education and/or experience was also present. Staff interview also conducted and documented. Please see LIC 809-C for continuance

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena Miller	TELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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: GENIUS KIDS DOUGHERTY	FACILITY NUMBER: 013423054
	VISIT DATE: 02/09/2022

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

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

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.

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 of the responsibility as a mandated reporter and the training's must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged facility representative to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees 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 to the regional office by phone and the written report, LIC 624 within 7 business days.

There are no deficiencies 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 facility representative, Deepa Shah.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena Miller	TELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2